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GOOD  HEALTH 


GOOD    HEALTH 


HOW  TO  GET  IT  AND  HOW  TO  KEEP  IT 


BY 

ALVAH  H.  DOTY,  M.D. 

AUTHOR  OF  "THE  PREVENTION  OF  INFECTIOUS  DISEASES,"  "THE  MOSQUITO,' 

"A  MANUAL  OF  INSTRUCTION  IN  THE  PRINCIPLES  OF  PROMPT 

AID  TO  THE  INJURED,"   ETC. 


ILLUSTRATED 


D.  APPLETON  AND  COMPANY 

NEW  YORK  LONDON 

1917 


Copyright,  1917,  by 
D.  APPLETON  AND  COMPANY 


TO  MY  FRIEND 

DR.  T.  MITCHELL  PRUDDEN 

A  TRIBUTE  TO  MANY  YEARS 
OF  PLEASANT  PERSONAL  AND 
PROFESSIONAL   ASSOCIATION 


PREFACE 

Years  ago  it  was  believed  that  matters  relating  to  the 
preservation  of  health  and  the  prevention  of  disease  should 
be  left  in  the  hands  of  physicians,  and  little  effort  was  made 
by  the  pubhc  in  aid  of  this  important  work.  Now  we  know 
that  the  health  of  a  community  depends  chiefly  upon  the 
exertion  of  its  individual  members  in  maintaining  not  only 
their  own  well-being,  but  also  that  of  their  neighbor.  This 
newer  conception  has  recently  led  to  a  stimulation  of  interest 
in  this  subject,  and  societies  are  being  organized  to  bring 
about  personal  cooperation  in  carrying  out  the  laws  of 
hygiene  and  sanitation.  It  is  essential  that  the  public 
should  become  familiar  with  recent  advances  which  have 
been  made  along  these  lines,  for  many  of  the  older  theories 
regarding  the  care  and  protection  of  the  body,  and  the 
means  by  which  diseases  are  transmitted,  have  been  proved 
to  be  erroneous. 

It  is  an  extremely  difficult  task  for  the  medical  profession, 
as  well  as  health  departments  and  other  public  agencies,  to 
attempt  to  combat  physical  inefSciency,  ill  health,  and  disease 
without  the  cooperation  of  those  for  whom  their  efforts  are 
so  generously  expended.  There  should  be  not  a  mere  passive 
acquiescence  in  following  the  teaching  of  sanitarians  or  in 
complying  with  health  ordinances,  but  an  intelligent  appre- 
ciation of  the  fundamental  principles  which  animate  them 
and  a  definite  sense  of  responsibility  in  maintaining  bodily 
health  for  both  individual  and  social  ends. 

The  terms  "hygiene"  and  "sanitation"  are  very  much  alike 
in  their  meaning  and  are  commonly  used  interchangeably.    By 

vii 


viii  PREFACE 


way  of  clearer  definition,  it  may  be  said  that  hygiene  refers 
more  particularly  to  the  care  of  the  body,  while  sanitation 
relates  rather  to  the  methods  of  maintaining  healthful  con- 
ditions in  the  environment  and  covers  matters  of  a  more 
general  and  extended  character;  for  instance,  school  sanita- 
tion, sanitation  of  the  workshop,  and  municipal  sanitation. 
It  is  sufficient  to  know  that  both  refer  to  the  preservation  of 
health  and  the  prevention  of  disease. 

It  has  been  the  aim  of  the  author  to  include  in  this  book 
the  essential  and  salient  points  in  the  construction  of  the 
body  and  function  of  its  various  parts;  also  to  discuss  pub- 
lic health  problems,  the  maintenance  of  individual  physical 
well-being,  the  means  by  which  infectious  diseases  are  trans- 
mitted and  how  they  may  be  prevented,  the  importance  of 
pure  air,  good  water  and  nourishing  food,  as  well  as  other 
matters  connected  with  the  subject  of  hygiene.  The  author 
has  endeavored  to  present  these  in  a  clear  and  simple 
manner,  and  in  a  way  that  will  make  the  application  of  the 
information  practicable  in  everyday  life  and  conduct. 


CONTENTS 

CHAPTER  I 

PAGE 

THE  STRUCTURE  OF  THE  BODY i 

The  Skeleton — Articulation — ^Joints — Muscles — 
Blood. 

CHAPTER  II 
THE  VITAL  PROCESSES:    CIRCULATION,   RES- 
PIRATION,   DIGESTION,    NERVOUS    SYSTEM 

AND  LYMPHATIC  SYSTEM 23 

Circulation — Blood-vessels — Heart — Respiration — 
Digestion — Kidneys — Skin — Spleen — Nervous 
System — ^Lymphatic  System. 

^       CHAPTER  III 
AIR •     .       62 

CHAPTER  IV 

WATER 69 

Preparation  of  Food — Distribution  of  Meals — Re- 
duction of  Weight. 

CHAPTER  V 

FOOD 86 

Nutrition — Diet — Preparation  of  Food — Distribu- 
tion of  Meals — Reduction  of  Weight. 

CHAPTER  VI 
DISPOSAL  OF  WASTE 122 

Sewage — Garbage . 

ix 


X  CONTENTS 

CHAPTER  VII  PAGE 

VENTILATION 133 

CHAPTER  VIII        / 
HEATING  AND  LIGHTING 141 

Heating — Lighting. 

CHAPTER  IX 

PERSONAL  HYGIENE 147 

Food  and  Drink — Exercise — Bathing — Teeth — Eyes 
— Hands  and  Feet — Sleep — Clothing — Constipation 
— ^Vacations. 

CHAPTER  X 
HYGIENE  OF  THE  HOME,  SCHOOL  AND  WORK- 
SHOP       176 

Hygiene  of  the  Home — Hygiene  of  the  School — 
Hygiene  of  the  Workshop. 

CHAPTER  XI       ,, 

BACTERIA,   INFECTIOUS   DISEASES   AND   THE 
MEANS  BY  WHICH  THEY  ARE  TRANSMITTED     192 

Bacteria — Infectious  Diseases  and  the  Means  by 
Which  They  are  Transmitted. 

CHAPTER  XII 
MOSQUITOES  AND  FLIES  AND  THEIR  EXTER- 
MINATION  204 

Flies. 

CHAPTER  XIII 
TUBERCULOSIS 225 

CHAPTER  XIV 
DISINFECTANTS  AND  DEODORANTS  ....     235 


CONTENTS  xi 

CHAPTER  XV  PAGE 

PROMPT  AID  TO  THE  INJURED 242 

Hemorrhage — Shock — Collapse — Electric  Shock — 
Instructions  for  Resuscitation — Syncope — Fainting 
— Apoplexy  or  Stroke  of  Paralysis — Epilepsy — Hys- 
teria— Heat-Stroke,  Sun-Stroke,  Insolation,  Sun 
Fever,  Fever  Heat — ^Asphyxiation — Suffocation — 
Drowning — Burns  and  Scalds — Frost-Bite — ^Wounds 
— Fractures — Dislocations — Sprains. 

INDEX 289 


LIST  OF  ILLUSTRATIONS 

FIGURE  PAGE 

I. — The   skeleton 7 

2. — Biceps   at   rest i6 

3. — Biceps    contracted 16 

4. — Human   red   blood    corpuscles    and   two   white 

corpuscles         . 19 

5. — The  heart  and  large  blood-vessels     ...  29 
6. — Diagram  showing  course  of  the  blood  through 

the    heart -30 

7. — Showing    the    relative    position    of    heart    and 

lungs  in  the  cavity  of  the  chest     ...  33 

8. — The  jaws  and  the  teeth 37 

9. — Salivary  glands 38 

10. — The   stomach 41 

II. — Position  of  abdominal  contents  ....  43 
12. — Under  surface  of  the  liver,  showing  the  gall- 
bladder and  a  section  of  blood-vessels  .        .  45 

13. — The  pancreas 46 

14. — Vertical  section  of  a  kidney       ....  48 

15. — Section  of  skin  greatly  magnified     .         .         .  5^ 

16. — The  cerebrospinal  system  of  nerves  ...  54 

17. — Side  view  of  the  brain 55 

18. — Under  surface  of  brain 56 

19. — The  mosquito:    female 205 

20. — Manner  in  which  the  eggs  of  the  Culex  pipiens, 

or  common  house  mosquito,  are  deposited    .  207 

21. — Eggs  of  the  anopheles 208 

22. — The  mosquito  larva 209 

xiii 


xiv  LIST  OF  ILLUSTRATIONS 

FIGURE  PAGE 

23. — Position  of  larva  of  common  mosquito  in  ob- 
taining  air 210 

24. — Position  of  anopheles  larva  in  obtaining  air     .  21a 

25. — Pupa.    (Smith.) 211 

26. — Culex    pipiens,    or    common    house    mosquito, 

female 212 

2^. — Anopheles,  or  malarial  mosquito,  female  .        .  215 

28. — Stegomyia,  or  yellow  fever  mosquito,  female  .  215 
29. — Culex     sollicitans.       Salt     water     swamp,     or 

striped-legged  mosquito 219 

30. — Diagram  showing  the  position  of  the  important 

arteries 244 

31. — Artificial  respiration:  inspiration.     Pressure  off  255 

32. — ^Artificial  respiration:  expiration.     Pressure  on  255 


GOOD  HEALTH 


GOOD   HEALTH 


CHAPTER  I 

THE   STRUCTURE   OF   THE   BODY 

The  owner  and  master  of  a  human  body  cannot 
hope  to  manage  it  properly,  secure  and  maintain  its 
usefulness  and  enjoyment,  safeguard  it  in  the  diverse 
struggles  of  life  and  occupation,  and  protect  it  against 
sickness  and  disease  without  some  precise  knowledge 
of  its  construction  and  the  various  things  which  its 
organs  are  made  to  do. 

Some  glimpses  in  brief  of  the  structure  and  func- 
tion of  the  body  will  therefore  fittingly  introduce  a 
book  designed  to  foster  in  direct  and  practical  fash- 
ion the  welfare  of  its  readers. 

THE   SKELETON 

In  the  study  of  this  subject  it  is  proper  that  we 
should  begin  with  an  examination  of  the  skeleton, 
for  this  constitutes  the  framework  of  the  body  and 
supports  and  protects  the  various  organs  which  are 
found  within  the  several  cavities  formed  by  the  struc- 
tures. In  order  to  perform  these  functions,  the  skele- 
ton must  be  composed  of  a  hard  and  unyielding  ma- 
terial which  retains  its  shape,  but  it  must  have  at  the 
same  time  a  certain  degree  of  elasticity.     For  these 

I 


2  GOOD  HEALTH 

reasons  the  skeleton  is  constructed  of  bone,  and  it  will 
be  of  interest  to  learn  something  of  the  composition 
and  peculiarities  of  this  substance. 

Bone  consists  of  animal  and  earthy  matter.  The 
former  is  chiefly  a  substance  which  is  converted  by 
boiling  into  gelatin.  It  also  contains  fat  and  blood- 
vessels. The  animal  tissue  in  bone  makes  it  tough 
and  elastic,  while  the  earthy  matter,  known  as  *'bone 
earth,"  consisting  principally  of  phosphate  of  lime, 
furnishes  the  required  hardness. 

In  very  early  life  the  animal  matter  forms  about 
one-third  and  the  earthy  matter  two- thirds  of  bone; 
later  in  life,  the  proportion  of  lime  is  somewhat  in- 
creased in  amount,  and  the  bone  becomes  denser. 
This  explains  why  the  bones  of  children  are  more 
elastic  than  those  of  adults.  When  considerable 
force  is  used  a  child's  bone  is  apt  to  bend  like  a 
green  stick,  rather  than  break  through,  as  in  the  case 
of  adult  bone. 

Rickets  is  a  disease  of  childhood,  and  is  due  chiefly 
to  an  insufficient  amount  of  earthy  matter.  In  this 
condition  the  bones,  for  want  of  hardness,  become 
bent  and  distorted,  the  deformity  being  particularly 
marked  in  the  bones  of  the  lower  extremity  which, 
for  the  time  being  at  least,  are  unable  to  support  the 
weight  of  the  body  properly. 

Bone  is  composed  of  compact  and  cancellated  tis- 
sue. The  former  consists  largely  of  earthy  matter 
and  is  exceedingly  dense  and  hard  like  ivory.  The 
latter  is  a  network  of  thin  plates  or  columns  and  is 
sponge-like  in  appearance.    The  compact  tissue  forms 


THE  STRUCTURE  OF  THE  BODY  3. 

the  outer  portions  of  bone  and  is  increased  in  amount 
where  great  strength  is  required,  as  in  the  shaft  of  the 
femur  or  thigh  bone.  The  cancellated  tissue  is  par- 
ticularly abundant  where  bones  become  enlarged  in 
order  to  form  joints,  as  in  the  ends  of  the  long  bones. 
Although  cancellated  tissue  is  very  light,  it  is  also 
very  strong ;  a  portion  corresponding  in  size  and  shape 
to  a  piece  of  loaf  or  lump  sugar  will  support  a  weight 
of  three  or  four  hundred  pounds.  A  piece  of  com- 
pact tissue  an  inch  square  and  half  an  inch  in  thick- 
ness will  support  a  weight  of  five  thousand  pounds.. 
In  formation  of  the  skull,  where  great  strength  is- 
necessary  to  protect  the  brain,  the  bone  is  composed 
of  two  layers  of  compact  tissue  with  a  small  amount 
of  cancellated  tissue  between. 

The  long  bones  are  hollow  for  the  same  reason  that 
tubular  columns  are  used  in  constructing  a  building — 
to  secure  strength  with  the  minimum  weight.  The 
hollow  part  or  canal  in  the  shaft  of  long  bones,  as  well 
as  cancellated  tissue,  contains  a  substance  called 
marrow  or  oil  of  bone.  In  the  canals  this  substance 
is  known  as  yellow  marrozv,  and  is  composed  almost 
entirely  of  fat.  That  found  in  the  cancellated  or 
spongy  tissue  of  bone  and  known  as  red  marrow  is 
three-fourths  composed  of  water  and  contains  but  a 
small  amount  of  fat.  In  very  early  life  all  the  mar- 
row of  bone  is  of  the  red  kind.  It  is  now  known  that 
all  of  the  red  corpuscles  and  some  of  the  white  cor- 
puscles, or  leukocytes,  of  the  blood,  which  will  be 
referred  to  again  later,  are  formed  in  the  red  marrow 
of  bone.     In  addition,  the  yellow  marrow  has  some- 


4  GOOD  HEALTH 

thing  to  do  with  the  nourishment  of  the  tissues,  par- 
ticularly in  emergencies. 

The  canals  in  the  bones  of  birds  communicate  with 
the  lungs,  and  contain  air  instead  of  marrow,  thus 
rendering  them  very  light  and  properly  adapted  to 
flight. 

Bone  is  supplied  with  nutrition  from  two  sources : 
the  periosteum  and  the  nutrient  arteries. 

The  periosteum  is  a  firm  and  resisting  fibrous  mem- 
brane, pinkish  in  color  and  closely  adherent  to  the 
bone.  It  covers  it  at  all  points  except  at  the  ends 
where  joints  are  formed  and  where  cartilage  exists. 
In  the  substance  of  periosteum  are  found  blood-ves- 
sels which  divide  and  subdivide  and  pass  into  minute 
openings  in  the  compact  tissue  of  bone  to  supply  its 
outer  surface  with  nutrition.  When  the  periosteum  is 
detached  from  a  bone,  either  by  accident  or  other- 
wise, the  compact  tissue  is  deprived  of  its  principal 
means  of  nutrition,  and  death  or  '"necrosis" — corre- 
sponding to  ''gangrene"  in  the  soft  tissues — follows. 
The  nutrient  arteries  supply  the  interior  of  the  bone 
with  nourishment. 

Bones  are  also  supplied  with  nerves  and  absorbents 
or  lymphatics.  The  power  of  absorption  possessed 
by  the  latter  is  so  great  that  ivory  pegs  employed  to 
hold  in  place  the  broken  ends  of  bone  unable  to  unite 
by  natural  processes,  have  been  absorbed. 

The  shape  of  a  bone  depends  largely  upon  its  use. 
The  long  bones,  of  which  the  femur  or  thigh  bone  is 
a  type,  are  not  only  used  for  support,  but  act  as 
levers  to  lift  or  move  the  various  parts  of  the  body 


THE  STRUCTURE  OF  THE  BODY  5 

through  muscular  attachment.  They  are  composed  of 
a  shaft  and  two  extremities.  The  short  bones  are 
found  where  a  number  of  joints  are  required  for  Hm- 
ited  motion  combined  with  strength — for  instance,  the 
carpus  or  wrist.  Flat  bones  aid  in  the  construction  of 
cavities,  help  to  protect  their  contents,  and  provide 
for  muscular  attachment,  as  the  bones  of  the  skull 
and  shoulder  blades.  Examples  of  irregular  bones 
are  the  superior  and  inferior  maxillary  bones,  or  the 
upper  and  lower  jaw,  and  the  vertebrae  or  bones 
forming  the  spine. 

The  skeleton,  which  is  composed  of  two  hundred 
bones,  not  including  some  small  ones  in  the  ear,  is 
the  framework  of  the  body;  it  supports  the  soft  tis- 
sues, protects  the  internal  organs,  and  serves  for  the 
attachment  of  muscles.  It  consists  of  a  central  col- 
umn or  spine,  four  extremities — two  upper  and  two 
lower — and  three  bony  cavities,  namely,  the  cranium 
or  skull,  containing  the  brain,  the  thorax  or  chest, 
enclosing  the  heart  and  lungs,  and  the  pelvis  or  basin, 
holding  the  pelvic  and  some  of  the  abdominal  or- 
gans.   The  arrangement  of  the  bones  is  as  follows : 

Spine 26 

Skull 22 

Hyoid  bone    I 

Sternum    i 

Ribs   24 

Upper  extremities    64 

Lower  extremities   62 


200 


6  GOOD  HEALTH 

The  spine  or  backbone,  which  is  about  one-third 
the  length  of  the  body,  is  an  articulated  column  com- 
posed of  a  number  of  bones  (vertebrae)  joined  to- 
gether and  forming  three  slight  curves  which  aid  in 
the  formation  of  cavities  for  the  protection  of  in- 
ternal organs.  These  curves  also  add  strength  to  the 
column  and  go  far  to  diminish  shocks  to  the  spinal  cord 
and  brain  which  might  occur  if  the  column  were 
straight.  The  spine  supports  the  skull  and  its  contents 
and  protects  the  spinal  cord,  which  is  contained  in  a 
canal  formed  by  the  union  of  the  vertebrae.  The  spinal 
column  rests  upon  the  posterior  and  upper  portions  of 
the  pelvis. 

The  freest  movement  of  the  spine  is  found  in  the 
neck  or  cervical  region,  and  the  least  in  the  back  be- 
tween the  shoulders  where  the  ribs  are  connected  with 
the  spine.  The  weakest  part  of  the  spine  is  at  its 
lowest  part  where  the  column  is  very  movable. 

The  skull  is  for  the  lodgment  and  protection  of  the 
brain  and  its  membranes,  blood-vessels  and  nerves.  In 
A'ery  early  life  bone  is  not  hard  but  is  somewhat  simi- 
lar in  consistence  to  cartilage.  The  fontanelles,  or 
''soft  spots,"  on  an  infant's  head  represent  bones 
which  have  not  become  hardened  or  ossified,  or 
brought  closely  and  firmly  together  by  this  process. 
This  condition  usually  disappears  after  the  child  is  a 
year  or  so  old.  At  birth  and  for  some  time  after- 
wards even  the  long  bones  are  not  sufficiently  hard 
or  dense  to  be  capable  of  supporting  the  body;  and 
for  this  reason  infants  should  not  be  placed  on  their 
feet  too  early. 


Fig.   I. — The  skeleton. 
.    7 


8  GOOD  HEALTH 

A  large  opening  exists  at  the  base  of  the  skull  called 
the  foramen  magnum,  through  which  the  spinal  cord 
passes  from  the  brain  to  the  canal  in  the  vertebral 
column.  Other  and  smaller  openings  are  found  in 
the  skull  for  the  passage  of  blood-vessels  and  nerves. 

The  hyoid  hone  is  a  small  and  somewhat  horse- 
shoe shaped  bone  found  above  the  *'Adam's  apple." 
It  helps  to  support  the  tongue  and  also  furnishes  at- 
tachment for  muscles. 

The  sternum  or  breast  hone  is  flat  and  narrow,  about 
seven  inches  long,  and  may  be  easily  felt  under  the 
skin  in  the  front  and  upper  part  of  the  chest.  It 
supports  the  clavicles,  or  collar  bones,  and  the  front 
end  of  the  ribs  with  the  exception  of  the  last  two. 

There  are  twenty- four  rihs,  twelve  on  each  side, 
being  numbered  from  above  downwards.  All  of  them 
articulate  or  join  in  the  back  with  the  vertebrae  or 
spinal  column,  and  in  the  front  the  upper  ten  con- 
nect through  the  medium  of  cartilage  with  the  ster- 
num. The  two  lower  ribs,  the  eleventh  and  the 
twelfth,  are  connected  only  with  the  spinal  column 
behind,  and  are  known  as  ^'floating  ribs."  These  are 
rarely  broken,  for  when  struck  or  rested  upon,  they 
sink  inwards  because  they  have  but  one  attachment, 
and  usually  escape  injury. 

The  peculiar  arrangement  of  the  ribs  renders  them 
very  important  agents  of  respiration,  for  when  they 
are  elevated  by  muscular  action  during  inspiration, 
the  chest  becomes  enlarged  and  the  air  passes  readily 
into  the  lungs.  In  expiration  the  ribs  are  depressed, 
the  chest  cavity  is  diminished  in  size,  and  the  air  in  the 


THE  STRUCTURE  OF  THE  BODY  9 

lungs  is  expelled.  The  diaphragm,  which  will  be  re- 
ferred to  again  later  on,  plays  an  even  more  important 
part  than  the  ribs  in  connection  with  respiration. 

Each  upper  extremity  is  composed  of  thirty-two 
bones,  named  as  follows :  scapula  or  shoulder  blade ; 
clavicle  or  collar  bone;  humerus  or  arm  bone;  ulna 
and  radius,  the  bones  of  the  forearm;  eight  carpal 
bones,  composing  the  wrist;  five  metacarpal  bones, 
forming  the  framework  of  the  palm  and  back  of  the 
hand,  and  fourteen  phalanges  or  bones  composing  the 
fingers  and  thumbs. 

The  scapula  is  a  thin,  flat,  triangular  bone,  situated 
at  the  upper  part  of  the  back.  It  joins  the  clavicle  and 
humerus  at  its  outer  end  or  border.  It  helps  to  pro- 
tect the  contents  of  the  chest  and  forms  a  broad  sur- 
face for  the  attachment  of  muscles. 

The  clavicle  is  shaped  somewhat  like  the  italic  letter  s, 
and  may  be  easily  felt  as  the  upper  and  most  super- 
ficial bone  at  the  base  of  the  neck  in  front.  It  extends 
from  the  sternum  to  a  process  on  the  outer  portion  of 
the  shoulder  blade;  it  holds  the  latter  upward,  back- 
ward and  outward. 

,  The  humerus  is  the  longest  and  strongest  bone  of 
the  upper  extremity.  It  has  a  shaft  and  two  extremi- 
ties, the  upper  one  being  received  in  a  cup-like  depres- 
sion in  the  outer  part  of  the  shoulder  blade.  The 
humerus  has  a  greater  range  of  motion  than  any  other 
bone  in  the  body,  and  is  most  often  removed  from  i4;s 
position  and  dislocated. 

The  ulna  and  radius  compose  the  forearm ;  the  ulna 
with  the  humerus  forms  the  elbow- joint.     The  upper 


10  GOOD  HEALTH 

end  of  the  radius  does  not  take  part  in  this  joint  or 
articulation.  It  is  attached  by  ligaments  to  the  outer 
side  of  the  ulna,  over  which  it  freely  ghdes  or  rotates, 
allowing  the  hand  to  move  inwards  and  outwards. 
Its  lower  end,  which  is  comparatively  broad,  takes 
part  in  the  formation  of  the  wrist-joint.  The  ulna 
takes  no  part  in  this  articulation. 

The  carpus  or  wrist  is  composed  of  eight  small 
irregular  bones  arranged  in  two  rows.  This  arrange- 
ment insures  strength,  motion  and  elasticity. 

The  metacarpus  consists  of  five  long  bones  con- 
necting the  wrist  with  the  bones  of  the  fingers  and 
thumb,  and  forms  the  framework  of  the  palm  and 
back  of  the  hand,  where  they  may  be  easily  identified. 

The  phalanges,  which  are  miniature  long  bones,  are 
fourteen  in  number :  three  for  each  finger  and  two  for 
the  thumb.  '  Their  position  may  be  easily  demon- 
strated by  bending  or  flexing  the  fingers.  This  ar- 
rangement is  such  that  when  the  hand  is  opened,  the 
fingers  do  not  correspond  in  length ;  but  when  closed, 
as  in  grasping  an  object,  there  is  no  apparent  differ- 
ence. This  is  necessary,  for  if  the  fingers  when  closed 
were  uneven,  the  grasping  power  of  the  hand  would 
be  diminished. 

Each  lower  extremity  consists  of  thirty-one  bones, 
one  less  than  in  the  upper  extremities.  They  are  as 
follows :  the  haunch  or  pelvic  bone ;  the  femur  or 
thigh  bone ;  the  tibia,  leg  or  shin  bone ;  and  the  Hhula 
or  splint  bone;  the  tarsal  bones  (seven)  or  instep;  the 
metatarsal  bones  (five)  or  ankle;  the  phalanges  or 
toes,  and  the  patella  or  knee  cap. 


THE  STRUCTURE  OF  THE  BODY  ii 

The  pelvis  is  composed  of  the  haunch  bones  and 
two  smaller  ones  which  join  them  behind,  the  sacrum 
and  coccyx,  constituting  the  lower  portions  of  the  ver- 
tebral column.  The  pelvis  supports  the  trunk  of  the 
body  and  protects  the  pelvic  and  some  of  the  abdom- 
inal organs. 

The  femur  is  the  strongest  and  longest  bone  in  the 
body.  Its  length  is  characteristic  of  the  human  skele- 
ton. In  the  erect  position  of  man,  the  tips  of  the 
fingers  reach  to  about  the  middle  of  the  thigh,  while 
in  the  orang-outang,  the  fingers  reach  to  the  ankle. 
This  difference  is  also  due  to  the  comparative  short- 
ness of  the  arms  in  the  human  skeleton.  The  upper 
end  of  the  femur  is  composed  of  a  spherical  head 
which  connects  obliquely  with  the  shaft  of  the  bone 
by  a  long  neck.  The  function  of  the  latter  is  to  keep 
the  thigh  bone  a  proper  distance  from  the  pelvis  and 
to  prevent  interference  with  locomotion.  This  round 
head  rests  in  a  depression  or  socket  in  the  pelvis. 
The  lower  end  of  the  femur  i^  very  large  and  broad, 
and  articulates  with  the  upper  extremity  of  the  tibia 
and,  with  the  patella,  or  knee  cap,  forms  the  joint. 

The  tibia  or  shin  bone  and  fibula  or  splint  bone 
form  the  leg.  The  tibia,  which  is  very  superficial, 
having  only  the  skin  as  a  cover,  is  the  larger  of  these 
two  bones,  and  is  constructed  mainly  for  strength  and 
support,  although  some  muscles  are  attached  to  it. 
The  fibula,  companion  bone  of  the  tibia,  is  external  to 
it  and  very  slim.  It  aids  in  supporting  the  tibia,  takes 
part  in  the  formation  of  the  ankle-joint,  and  furnishes 
attachment  for  a  number  of  muscles. 


12  GOOD  HEALTH 

The  tarsus,  or  instep,  corresponds  to  the  carpus,  or 
wrist,  in  the  upper  extremities ;  it  consists  of  seven 
bones,  while  eight  bones  form  the  wrist.  The  tarsal 
bones,  which  form  the  arch  of  the  foot,  possess  great 
strength;  this  is  necessary  to  support  the  weight  of 
the  body.  If  the  ligaments  and  other  tissues  which 
hold  the  bones  of  the  tarsus  together,  particularly 
underneath,  become  relaxed,  torn,  or  otherwise  dis- 
abled, the  instep  sinks,  the  arch  of  the  foot  is  more 
or  less  destroyed,  and  what  is  known  as  ''flat  foot"  or 
''broken  arch"  occurs.  This  not  infrequently  follows 
certain  diseases  of  the  bone.  Some  people  are  natu- 
rally flat-footed. 

The  metatarsal  bones  of  the  foot  correspond  to  the 
metacarpal  bones  of  the  hand  and  are  the  same  in 
number.     They  form  the  framework  of  the  foot. 

The  phalanges  are  fourteen  in  number  and  corre- 
spond to  the  phalanges  of  the  hand. 

The  patella,  or  knee  cap,  is  situated  in  front  of  the 
knee-joint.  It  lies  in  the  tendon  of  a  large  muscle, 
and  assists  in  the  formation  and  protection  of  this 
joint.  When  the  leg  is  extended  and  the  muscle  re- 
laxed, the  patella  will  be  found  to  be  freely  movable. 
Sometimes  the  little  closed  sack  over  the  patella,  the 
interior  of  which  is  moistened  with  a  fluid  to  prevent 
friction,  becomes  injured  and  inflamed  and  very  much 
increased  in  size,  due  to  the  presence  of  the  fluid. 
This  is  known  as  "house-maid's  knee,"  for  it  is  some- 
times produced  by  resting  on  the  knees,  as  in  the  act 
of  scrubbing.  There  are,  however,  other  and  probably 
more  frequent  causes  for  this  affection. 


THE  STRUCTURE  OF  THE  BODY  13 

ARTICULATION— JOINTS 

Bones  are  connected  at  different  points  in  the  skele- 
ton ;  such  a  connection  is  called  an  articulation  or 
joint.  Some  are  immovable — those  in  the  skull,  for 
instance;  others  slightly  movable,  as  the  joints  of  the 
spine ;  while  the  greater  number  are  freely  movable, 
as  the  knee  and  shoulder  joints  and  joints  of  the 
fingers  and  toes. 

Some  joints  have  a  gliding  movement,  as  the  wrist 
and  instep.  A  ball  and  socket  joint,  where  a  globular 
head  is  received  in  a  cup-like  cavity,  permits  move- 
ment in  several  directions,  as  in  the  shoulder  and  hip. 
In  a  hinge  joint  the  motion  is  limited  to  a  forward  and 
backward  movement,  as  at  the  elbow  and  knee. 

The  structures  entering  into  the  formation  of  joints 
are  as  follows :  bone,  cartilage,  ligaments,  tendons, 
synovial  memhranes,  blood-vessels,  and  nerves.  Bone 
has  already  been  described. 

Cartilage,  or  ''gristle,"'  covers  the  ends  of  bones 
which  form  joints.  It  acts  as  a  buffer,  protecting  the 
adjacent  bony  surfaces  from  friction  and  prevent- 
ing shock  which  would  occur  if  these  surfaces  were 
directly  applied  to  each  other.  This  is  particularly 
noticeable  in  the  vertebrae  of  the  spinal  column. 

The  continual  pressure  brought  to  bear  on  cartilage 
would  cause  pain,  inflammation  and  disease  if  it  were 
supplied  with  blood-vessels  and  nerves ;  consequently 
it  is  destitute  of  these  structures,  and  is  known  as 
non-vascular  tissue.  It  absorbs  its  nourishment 
from  the  surrounding  parts  by  the  process  known  as 


14  GOOD  HEALTH 

imbibition.  Cartilage  is  also-  found  lining  tubes,  such 
as  the  air  passages,  ears  and  nose,  where  it  is  necessary 
that  channels  be  kept  permanently  open. 

Continued  pressure  on  cartilage  diminishes  its  thick- 
ness, and  during  the  day  we  may  lose  half  an  inch  or 
so  in  height.  However,  rest  and  the  recumbent  posi- 
tion at  night  restore  the  cartilage  to  its  proper  thick- 
ness. Leaning  too  much  on  one  side  may  cause  a  per- 
manent change  in  the  cartilage,  and  consequent  de- 
formity. 

Ligaments  are  composed  of  two  kinds  of  tissue : 
white  Hhrous  and  yellow  elastic.  The  former  are  more 
common  and  connect  the  extremities  of  bones  forming 
the  joints.  White  fibrous  tissue  is  very  strong  and 
flexible  but  it  does  not  stretch;  and  while  it  permits 
the  necessary  movements  of  the  joints,  it  does  not  al- 
low the  articular  ends  of  the  bone  forming  the  joint  to 
become  displaced.  When  a  bone  is  dislocated,  the 
ligaments,  as  a  rule,  are  either  ruptured  or  torn  from 
their  attachment. 

The  ligaments  composed  of  yellow  elastic  tissue 
are  very  elastic,  and  are  found  in  parts  where  con- 
siderable range  of  motion  is  required,  as  in  the  cervi- 
cal region  of  the  spinal  column.  This  elasticity  aids 
in  returning  the  parts  to  their  proper  place  after 
movement. 

Synovial  membranes  are  delicate  structures  con- 
nected with  the  movable  joints  lining  the  inner  side 
of  ligaments;  but  they  do  not  extend  between  the 
articular  surfaces  of  the  bone.  They  secrete  a  thick, 
glairy  fluid,  resembling  the  white  of  egg,  and  known 


THE  STRUCTURE  OF  THE  BODY  15 

as  synovia  or  "joint  oil/'  the  function  of  which  is  to 
lubricate  the  surfaces  of  the  joint,  and  thus  prevent 
friction.  These  membranes  often  become  inflamed; 
this  condition  is  called  ''synovitis." 

MUSCLES 

Muscles  are  bundles  of  reddish-brown  fibers,  having 
the  power  of  contraction.  There  are  two  kinds :  vol- 
untary or  striped  muscles,  and  involuntary  or  un- 
striped  muscles.  The  terms  "striped"  and  "unstriped" 
refer  to  the  microscopical  appearance  of  the  individual 
fibers  composing  the  muscles. 

The  voluntary  muscles  are  under  the  control  of  the 
will,  and  comprise  the  bulk  of  the  muscular  system. 
They  are  attached  to  the  different  parts  of  the  skele- 
ton and  act  on  the  bones  as  levers ;  they  are  agents 
of  locomotion.  They  also  protect  the  various  struc- 
tures beneath  them,  and  give  grace  and  symmetry  to 
the  form.  When  the  muscles  are  poorly  developed  or 
become  diminished  in  size,  a  person  becomes  angular 
and  bony.  The  lean  meat  of  animals  used  for  food 
is  voluntary  or  striped  muscular  tissue. 

The  voluntary  muscles  differ  in  length  and  shape, 
and  are  designated  as  long,  short,  broad,  etc.  They 
are  arranged  in  pairs,  for  as  a  rule  there  are  corre- 
sponding muscles  on  each  side  of  the  body. 

There  are  over  four  hundred  muscles  attached  to 
the  human  frame.  At  many  points  their  outlines  are 
apparent  to  the  eye,  and  are  used  by  physicians  as 
guides  to  the  location  of  important  vessels  and  nerves. 

Muscles    are    surrounded   by    thin    web-like    tissue 


i6 


GOOD  HEALTH 


known  as  fascia,  which  serves  as  a  support  and  les- 
sens friction  while  the  muscles  are  in  action. 


Fig.  2. — Biceps  at  rest. 

Voluntary  muscles  are  composed  of  a  belly  and  two 
extremities.     The  more  fixed  extremity  is  called  the 


Fig.  3. — Biceps  contracted. 

origin,  and  the  movable  one  the  insertion,  though  in 
some  muscles  the  origin  and  insertion  are  equally  mov- 


THE  STRUCTURE  OF  THE  BODY  17 

able.  During  contraction  the  origin  and  insertion 
draw  closer  together,  the  muscle  in  action  thereby 
becoming  shorter  and  thicker.  This  can  be  easily  dem- 
onstrated by  raising  a  heavy  weight  with  the  hand, 
when  the  ''biceps,"  the  large  muscle  on  the  front 
of  the  upper  arm,  will  be  seen  to  thicken  and  bulge 
forward. 

Muscles  gradually  diminish  in  size  towards  their 
extremities.  The  fibers  at  this  point  are  replaced  by 
a  firm  and  resisting  substance  composed  of  white 
fibrous  tissue  known  as  "tendon."  This  is  directly 
and  intimately  connected  with  the  periosteum,  and 
sometimes  directly  with  the  bone.  Tendons  differ  in 
appearance  from  the  muscular  tissue  in  being  white 
and  glistening.  An  "aponeurosis"  is  simply  an  ex- 
panded tendon  and  is  found  where  the  muscle  has  a 
broad  attachment. 

Muscles  are  abundantly  provided  with  blood-vessels, 
nerves  and  lymphatics  in  order  that  there  may  be  a 
constant  supply  of  nourishment,  that  there  may  be 
a  prompt  response  to  stimulus  from  the  nerve  cen- 
ters, and  also  that  waste  matter  may  be  absorbed. 
Tendons  have  but  few  blood-vessels,  and  only  those 
of  larger  size  have  nerves. 

In  the  disease  known  as  tetanus  or  "lock  jaw,"  the 
nerve  stimulus  is  so  strong  and  the  contraction  of 
the  muscles  so  powerful  that  fibers  are  sometimes  rup- 
tured. The  stiffness  of  the  body  which  ensues  after 
death,  known  as  "rigor  mortis,"  is  due  to  the  solidifi- 
cation of  some  of  the  fluid  portions  of  the  muscles; 
this  again  is  followed  within  a  few  hours  by  the  re- 


i8  ^  GOOD  HEALTH 

laxation  of  the  body.  It  is  believed  that  this  rigidity 
is  not  so  apt  to  occur  in  persons  killed  by  light- 
ning. 

If  muscles  are  not  sufficiently  used  they  become 
diminished  in  size  and  atrophy  takes  place.  From 
continued  non-use  they  may  undergo  degeneration, 
from  which  there  is  no  recovery,  for  nature  is  not 
favorable  to  tissue  which  is  of  no  use.  Thus  the 
value  of  exercise  is  apparent.  Hypertrophy  repre- 
sents the  opposite  condition  to  atrophy,  and  the  mus- 
cles become  increased  in  size.  This  is  due  to  unusual 
and  continued  exercise  and  activity.  The  heart  muscle 
becomes  hypertrophied  when  it  is  necessary  that  this 
organ  make  up  for  the  partial  loss  of  function  due  to 
diseased  valves. 

The  involuntary  or  unstriped  muscles,  which  are 
not  under  the  control  of  the  will,  are  not  connected 
with  bones,  but  form  the  muscular  covering  of  some 
of  the  internal  organs,  as  the  stomach  and  intestines, 
and  also  the  muscular  coat  of  the  blood-vessels.  The 
contraction  of  this  form  of  muscular  fiber  is  not 
abrupt  and  rapid  as  in  voluntary  muscles,  but  slow, 
worm-like  and  unequal,  and  does  not  affect  all  portions 
of  the  muscles  at  the  same  time.  The  value  of  this 
during  digestion  will  be  referred  to  later.  The  invol- 
untary muscles  have  no  tendons,  the  muscular  fibers 
simply  interlacing  with  each  other.  Although  the 
heart  is  an  involuntary  muscle  and  not  under  the  con- 
trol of  the  will,  the  fibers  are  striped  in  a  manner 
somewhat  similar  to  voluntary  muscular  fibers.  This 
is  the  only  instance  of  the  kind. 


THE  STRUCTURE  OF  THE  BODY  19 

BLOOD 

Blocxi  is  the  great  nutritive  fluid  of  the  body;  it 
distributes  to  the  different  tissues  oxygen  and  nourish-^ 
ment  necessary  for  their  existence.  If  the  system  is 
not   constantly   supplied   with   oxygen,    death   quickly^ 


Fig.  4. — Human  red  blood  corpuscles  and  two  white  corpuscles. 

follows,  as  in  drowning.  The  blood  has  also  the  Yery 
important  function  of  removing  from  the  body  through 
certain  organs,  principally  the  kidneys,  lungs  and  skin,, 
worn  out  and  waste  matter  which,  if  retained,  may 
either  seriously  affect  the  health  or  prove  fatal. 

Blood  is  composed  of  liquid  and  solid  matter. 
The  former  is  known  as  plasma  and  constitutes  about 
two-thirds  of  the  blood;  it  is  almost  colorless  whea 
separated  from  the  soHd  matter,  or  corpuscles.     The 


20  GOOD  HEALTH 

plasma  contains  the  principal  elements  of  nutrition 
which  it  distributes  to  the  various  tissues  through  the 
body,  receiving  in  return  waste  matter  to  be  discharged 
through  the  different  excretory  organs. 

The  corpuscles  or  solid  portion  of  the  blood  in  the 
plasma  are  divided  into  red  and  white  corpuscles,  the 
latter  being  known  as  *ieukocytes." 

The  red  corpuscles  are  far  more  numerous  and  con- 
spicuous than  the  leukocytes  or  white  corpuscles,  and 
resemble  in  appearance  a  coin  thinned  in  the  center  on 
both  sides,  or  bi-concave.  These  little  bodies  are  ex- 
ceedingly small,  thirty-five  hundred  of  them  laid  side 
by  side  on  their  flat  surface  being  required  to  cover  the 
space  of  an  inch,  and  they  of  course  are  not  visible  to 
the  naked  eye.  Physiologists  have  calculated  that 
there  are  over  fifty  billion  red  corpuscles  in  the  human 
body.  When  examined  individually  under  the  micro- 
scope they  appear  straw-colored,  but  when  vast  num- 
bers are  crowded  together,  they  present  the  charac- 
teristic red  color.  They  are  oxygen  carriers.  They  re- 
ceive this  gas  from  the  air  in  the  lungs  and  distribute 
it  to  the  tissues  throughout  the  system. 

The  white  corpuscles  are  much  larger  than  the  red 
ones,  and  are  more  globular  in  form.  Until  recent 
years  the  function  of  the  white  corpuscles  was  in 
doubt;  now  it  is  known  that  besides  other  uses  they 
are  extremely  important  agents  in  the  destruction  of 
bacteria  or  germs  which  find  their  way  into  the  sys- 
tem. The  leukocytes  are  most  lusty  fighters,  and  with 
the  aid  of  the  microscope  may  be  seen  actually  to 
draw  the  infectious  germs  within  themselves  for  the 


THE  STRUCTURE  OF  THE  BODY  21 

purpose  of  destruction.  This  exceedingly  important 
and  interesting  function  will  be  referred  to  again  in 
a  subsequent  chapter. 

The  amount  of  blood  in  the  human  body  represents 
about  one-twelfth  of  its  weight.  It  is  an  alkaline 
fluid  and  heavier  than  water,  having  a  specific  gravity 
of  1055. 

Arterial  blood,  or  that  which  has  been  purified  in 
the  lungs,  is  bright  red  owing  to  the  presence  of 
oxygen;  while  the  venous  blood,  which  is  largely  de- 
prived of  oxygen  and  contains  poisonous  gas  and 
waste  matter,  is  of  a  bluish  or  purplish  color. 

Some  tissues,  such  as  hair,  cartilage  and  nai!s,  are 
not  supplied  with  blood,  but  receive  their  nutriment  by 
their  absorption  or  imbibition  in  a  manner  similar  to 
cartilage. 

Coagulation,  which  occurs  when  a  blood-vessel  is 
opened,  is  nature's  means  of  arresting  hemorrhage. 
Coagulation  sometimes  takes  place  within  vessels  them- 
selves under  certain  abnormal  conditions  of  the  blood 
or  vessels. 

In  connection  with  the  various  subjects  contained 
in  this  book  reference  will  frequently  be  made  to 
Organs,  glands,  secretions,  excretions,  and  mucous  and 
serous  membranes.  For  the  sake  of  convenience, 
these  terms  will  be  explained  together. 

An  organ  is  a  part  of  the  animal  system  having  a 
definite  function  to  perform;  for  instance,  the  heart. 

A  gland  is  also  an  organ,  but  in  addition  it  either 
takes  from  the  blood  certain  waste  or  poisonous  mat- 
ter  which   it   discharges    from   the   body   unchanged, 


Z2  GOOD  HEALTH 

known  as  an  excretion — as  the  urine — or  it  manu- 
factures from  material  removed  from  the  blood  a 
product  which  is  found  nowhere  else  and  is  employed 
in  the  body  for  a  special  purpose ;  this  is  a  secretion 
and  the  gastric  juice  is  an  example. 

Mucous  and  serous  membranes  are  found  in  the 
interior  of  cavities,  sacs  and  tubes.  Mucous  mem- 
branes line  structures  which  open  externally,  such  as 
the  respiratory  and  alimentary  tracts,  while  serous 
membranes  cover  the  inner  surface  of  cavities  and 
tubes  which  are  closed  and  have  no  communication 
with  the  outer  world,  such  as  the  pleural  and  peri- 
cardial cavities. 


CHAPTER  II 

THE     VITAL      processes:      CIRCULATION,      RESPIRATION^ 
DIGESTION,   NERVOUS  SYSTEM    AND   LYMPHATIC   SYSTEM. 

CIRCULATION 

Blood-Vessels 

In  order  that  our  bodies  may  be  kept  alive,  there 
must  be  some  form  of  transmission  or  circulation  by 
which  the  various  tissues  are  supplied  uninterruptedly 
with  nourishment.  The  need  of  that  is  not  confined  to 
human  beings  and  animals,  but  applies  to  the  lower 
forms  of  life  as  well  as  to  plants  and  trees.  The  tree 
obtains  its  nourishment  from  the  ground  and  trans- 
mits to  its  branches  material  to  maintain  their  exist- 
ence and  growth.  A  beautiful  illustration  of  this  may 
be  found  in  the  leaf  in  which  the  stem  divides  into 
many  little  ramifications  for  the  distribution  of  nour- 
ishment. In  the  higher  order  of  animal  life  nourish- 
ment is  transmitted  through  the  medium  of  blood, 
which  is  carried  tO'  every  part  of  the  system  by  tubes 
or  blood-vessels.  These  are  divided  into  arteries,, 
capillaries  and  veins. 

Arteries  are  vessels  which  carry  blood  away  fran 
the  heart.  The  aorta,  which  is  the  largest  artery  in 
the  body  and  the  beginning  of  the  arterial  system,  is 

2% 


24  GOOD  HEALTH 

connected  with  the  left  ventricle  of  the  heart,  and 
through  it  the  blood  passes  to  the  various  parts  of  the 
body. 

The  walls  of  the  arteries  are  composed  of  three 
coats  or  layers,  namely,  the  external,  middle  and  in- 
ternal coat.  The  external  coat  consists  of  white  fibrous 
tissue  which  is  very  strong  and  tough  and  whose  func- 
tion is  protective.  The  strength  and  resistance  of  this 
coat  are  well  exhibited  when  ligating  or  tying  an 
artery,  as  surgeons  are  often  obliged  to  do.  The  liga- 
ture is  passed  around  the  vessel  and  the  ends  drawn 
tightly  together  and  tied  for  the  purpose  of  closing 
the  artery.  This  constriction  usually  severs  the  middle 
and  internal  coats,  but  leaves  the  external  coat  practi- 
cally intact  or  without  serious  injury. 

The  middle  coat  of  the  arteries  is  composed  of  mus- 
cular and  yellow  elastic  tissue  which  exerts  a  pressure 
upon  the  contents  of  the  vessel  and  helps  to  regulate 
and  force  along  the  blood  supply.  The  large  amount 
of  yellow  elastic  tissue  in  the  arteries  explains  why 
the  coats  of  these  vessels  are  much  thicker  than  those 
of  the  veins.  It  also  accounts  for  the  elasticity  which 
is  characteristic  of  arteries,  and  for  the  fact  that 
arteries  remain  open  when  empty.  The  latter  condi- 
tion gave  rise  in  very  early  times  to  the  belief  that 
these  vessels  contained  only  air,  and  for  this  reason 
were  named  arteries  or  *'air  carriers." 

Arteries  pulsate,  and  when  severed  the  blood  es- 
capes in  spurts  and  jets.  This  is  due  principally  to  the 
action  of  the  heart  and  partly  to  the  contraction  of 
the  arteries  thems'elves. 


THE  VITAL  PROCESSES  25 

An  artery  in  its  normal  condition  may  be  likened 
to  a  rubber  tube.  If  water  is  forced  into  a  rubber  tube 
it  stretches  a  little  to  receive  the  fluid,  and  immediately 
contracts  to  its  original  caliber,  thus  aiding  in  forc- 
ing along  its  contents;  this  is  elasticity.  Time  and 
exposure  will  render  the  rubber  tube  stiff,  brittle  and 
weakened.  Under  these  conditions  it  is  not  elastic, 
and  when  force  is  applied  within  it  may,  under  suffi- 
cient pressure,  crack  or  break  open  with  an  escape  of 
its  contents. 

This  is  practically  what  occurs  in  so-called  "hard- 
ened" arteries  which  frequently  develop  late  in  life. 
The  middle  coat  containing  the  elastic  and  muscular 
tissue  undergoes  degeneration  and  becomes  weak  and 
brittle,  and  its  elasticity  largely  disappears.  When 
this  occurs  the  smaller  arteries  particularly  are  often 
unable  to  resist  the  pressure  of  blood.  The  rupture 
of  one  of  these  little  vessels  in  the  brain  giving  rise  to 
hemorrhage  and  pressure  upon  this  organ  causes  pa- 
ralysis in  some  part  of  the  body,  known  as  apoplexy. 
A  hemorrhage  on  one  side  of  the  brain  causes  paraly- 
sis on  the  opposite  side  of  the  body.  The  reason  for 
this  will  be  explained  in  the  section  relating  to  the 
nervous  system. 

As  arteries  go  farther  into  the  tissue,  they  become 
exceedingly  small  and  lose  their  external  and  middle 
layer,  and  have  but  one  coat.  They  are  then  known 
as  capillaries  and  become  so  minute  that  the  red  cor- 
puscles in  order  to  pass  through  are  sometimes  obliged 
to  "double  up"  and  pass  one  by  one.  The  thinness  of 
the  capillary  walls  and  the  slow  and  uniform  current 


26  GOOD  HEALTH 

of  blood  in  these  vessels  enable  them,  as  already  stated, 
to  supply  the  tissues  with  oxygen  and  nourishment 
urgently  needed,  and  to  receive  in  exchange  waste 
matter  which  is  thrown  out  of  the  body  by  the  excre- 
tory organs. 

The  capillaries,  after  having  supplied  nourishment 
to  the  tissues  and  received  waste  matter  in  return, 
take  on  a  second  coat,  and  later  still  another  one. 
These  vessels,  now  having  three  coats,  are  known  as 
veins.  The  middle  coat  contains  but  little  of  yellow 
elastic  tissue,  which  accounts  not  only  for  the  rela- 
tive thinness  of  the  walls  of  these  vessels  com- 
pared with  arteries,  but  also  for  the  fact  that  they 
collapse  when  empty.  Veins  do  not  pulsate  as  arteries 
do,  for  they  are  further  removed  from  the  action  of 
the  heart;  therefore,  hemorrhage  from  a  vein  is  a 
continuous  flow  rather  than  the  spurt  which  occurs 
when  an  artery  is  severed. 

With  the  exception  of  those  in  the  cranial,  thoracic 
and  abdominal  cavities,  veins  are  supplied  with  valves 
formed  by  a  duplication  or  folding  over  of  the  in- 
ternal coat  of  these  vessels ;  this  allows  the  blood  to 
flow  in  one  direction  only,  towards  the  heart.  These 
valves  are  very  necessary,  as  the  current  of  blood  in 
the  veins  is  mainly  upward  and  against  the  force  of 
gravity;  moreover,  the  pressure  of  the  blood  in  the 
veins  is  about  only  one-fourth  of  that  in  the  arteries. 
Sometimes  the  valves  become  useless,  and  distention 
and  distortion  of  the  vessels  occur.  This  is  noticeable 
in  the  condition  known  as  "varicose  veins,"  which 
often  occurs  in  the  legs. 


THE  VITAL  PROCESSES  27 

The  circulation  of  the  blood  throughout  the  body- 
takes  place  in  the  following  manner:  The  venous 
blood,  containing  worn  out  and  waste  matter  and  prac- 
tically deprived  of  oxygen,  is  collected  throughout  the 
body  by  two  large  veins  which  discharge  their  contents 
into  the  right  auricle  of  the  heart.  The  right  auricle 
contracts  and  forces  its  contents  into  the  right  ven- 
tricle. The  contraction  of  the  ventricle  follows.  The 
valve  guarding  the  opening  between  these  two  cavities 
closes,  and  the  blood,  unable  to  return  to  the  auricle, 
is  driven  into  a  large  blood-vessel  which  divides  and 
carries  the  blood  into  the  lungs.  Upon  reaching  the 
lungs  the  veins  grow  smaller  and  exceedingly  numer- 
ous, and  at  last  become  capillaries  and  surround  the 
minute  vesicles  or  pockets  composing  the  lungs.  Here 
a  most  important  change  takes  place ;  for  it  is  at  this 
point  that  the  blood  frees  itself  of  carbonic  acid  gas 
and  other  waste  and  poisonous  products  collected 
throughout  the  system  and  receives  in  return  oxygen 
from  the  air  contained  in  the  vesicles.  The  blood, 
now  purified  and  enriched  and  in  a  condition  to  nour- 
ish the  tissues  of  the  body,  is  forced  by  the  continuous 
action  of  the  right  side  of  the  heart  from  the  lungs 
into  the  left  auricle.  The  latter  then  contracts  and 
the  blood  passes  into  the  left  ventricle.  The  valve 
between  these  two  cavities  closes  as  it  does  on  the  right 
side,  and  the  blood  is  driven  into  the  aorta,  the  largest 
artery  in  the  body.  Thence  it  proceeds  into  the  smaller 
arteries,  and  ultimately  the  capillaries  where  the  in- 
terchange of  nourishment  and  waste  matter  takes 
place.    After  performing  this  function,  the  capillaries 


28  GOOD  HEALTH 

become  continuous  with  the  veins  and  the  circulation 
is  completed. 

Heart 

The  heart  is  a  pear-shaped  muscular  organ  or  pump, 
about  the  size  of  a  closed  fist  of  a  man.  The  average 
adult  heart  is  about  five  inches  long,  three  inches 
through,  and  weighs  from  eight  to  twelve  ounces.  It 
occupies  a  position  in  the  chest  just  behind  the  sternum, 
or  breast-bone,  and  lies  between  the  lungs  mainly  on 
the  left  side.  The  large  end,  or  base,  of  the  heart  is 
above  and  points  towards  the  right  side,  while  the 
smaller  end,  or  apex,  is  downward  and  to  the  left. 

A  line  drawn  across  the  sternum  or  breast  bone,  at 
the  upper  border  of  the  cartilage  of  the  third  rib  in 
front,  would  indicate  the  base  of  the  heart.  The  apex, 
or  smaller  end,  of  the  heart  is  found  between  the  fifth 
and  sixth  rib's  and  three  and  a  half  inches  to  the  left 
of  the  middle  line  of  the  chest ;  at  this  point,  the  pulsa- 
tion of  the  heart  can  be  distinctly  felt. 

The  heart  is  composed  of  four  cavities  or  chambers : 
two  auricles  and  two  ventricles.  The  auricles  are 
above  and  the  ventricles  below.  Again,  the  heart  may 
be  divided  into  a  right  and  left  side,  each  having  an 
auricle  and  ventricle.  The  ventricles  do  not  connect 
with  each  other  nor  do  the  auricles,  but  an  auricle 
connects  with  a  ventricle  of  the  corresponding  side. 
The  opening  between  the  auricle  and  ventricle  is 
guarded  by  a  valve  which  is  so  arranged  that  the  blood 
may  pass  from  the  auricle  to  the  ventricle,  but  in  nor- 
mal condition  it  cannot  return.     If  this  were  not  so 


THE  VITAL  PROCESSES 


29 


the  circulation  of  the  blood  would  be  constantly  inter- 
fered with.  The  ventricles  are  larger  than  the  auricles 
and  their  muscular  walls  are  much  stronger,  particu- 


FiG.  5. — The  heart  and  large  blood-vessels.  A,  right  ventricle;  B, 
left  ventricle;  C,  right  auricle;  D,  left  auricle;  E,  aorta;  F, 
pulmonary  artery. 

larly  those  of  the  left  ventricle,  which  must  drive  the 
blood  received  from  the  lungs  throughout  the  entire 
system.  The  auricles  contract  together,  as  do  the  ven- 
tricles. 

Between  the  complete  contraction  of  the  ventricles 


30 


GOOD  HEALTH 


and  the  beginning  of  the  contraction  of  the  auricles 
there  is  a  pause  which,  although  imperceptible,  pro- 
vides a  measure  of  rest  for  the  heart — a  very  import- 
ant consideration.  Otherwise  the  heart  would  be  un- 
able to  perform  its  function,  for  nature  requires  that 
all  organs  and  tissues  shall  have  a  period  of  repose. 


Fig.  6. — Diagram  showing  course  of  the  blood  through  the  heart. 


This  double  action — the  contraction  of  the  auricles 
and  ventricles — represents  one  pulsation  of  the  heart. 
There  are  from  sixty  to  eighty  pulsations  a  minute. 
The  heart  is  endowed  with  enormous  power ;  it  is  esti- 
mated that  the  energy  exerted  by  this  organ  in 
twenty-four  hours  would  raise  a  ton  weight  one  hun- 
dred and  twenty-five  feet  from  the  ground. 


THE  VITAL  PROCESSES  31 

The  cavities  of  the  heart  are  lined  with  a  very  deli- 
cate and  smooth  membrane  known  as  the  endocardium. 
The  endocardium  is  continuous  throughout  the  whole 
system  of  blood-vessels,  forming  the  internal  coat  or 
lining  of  the  arteries  and  veins,  and  the  only  coat  of 
the  capillaries.  The  function  of  this  lining  membrane 
is  largely  to  prevent  friction. 

It  is  also  necessary  to  protect  the  outside  of  the 
heart  from  contact.  For  this  reason  it  is  surrounded 
by  a  closed  sac  lined  with  a  serous  membrane  called 
the  pericardium.  One  side  of  this  sac  is  attached  to 
the  walls  of  the  heart;  the  other  to  the  surrounding 
tissue.  Below,  considerable  space  is  provided  in  which 
the  lower  portions,  or  apex,  of  the  heart  may  move 
about.  The  interior  of  this  sac  is  exceedingly  smooth 
and  contains  a  small  amount  of  fluid;  this  is  very 
necessary  as  the  constant  action  of  the  heart  would 
otherwise  excite  friction. 

RESPIRATION 

Respiration  is  the  act  or  process  of  breathing,  and 
IS  the  means  by  which  oxygen  contained  in  the  air  and 
necessary  to  our  existence  reaches  the  blood  for  dis- 
tribution throughout  the  body,  and  is  also  the  means 
by  which  poisonous  gases  and  waste  matter  are  thrown 
off  from  the  blood. 

Respiration  is  divided  into  inspiration  and  expira- 
tion. The  structures  involved  in  this  function  are  ^s 
follows :  Mouth,  nose,  larynx,  trachea,  bronchial  tubes 
and  the  air  vesicles  or  cells,  of  which  the  lungs  are 


32  GOOD  HEALTH 

chiefly  composed.  These  different  structures  consti- 
tute the  respiratory  tract. 

A  close  examination  of  the  throat  will  show  two 
openings.  The  back,  or  posterior,  one  is  the  upper  part 
of  the  esophagus  or  ''gullet."  In  front  of  this  and  just 
behind  and  below  the  base  of  the  tongue,  is  the  upper 
part  of  the  larynx  or  ''wind-pipe."  This  consists  of 
a  cartilaginous  box  containing  fibrous  bands  which 
stretch  from  the  front  backward,  two  on  each  side, 
one  above  the  other.  These  are  called  vocal  cords. 
The  upper,  or  superior,  pair  have  no  special  function 
known  at  present;  the  lower,  inferior  or  true,  vocal 
cords  are  extremely  important,  for  it  is  their  vibration 
during  expiration,  or  when  the  air  is  expelled  from  the 
lungs,  that  produces  the  voice. 

The  larynx  may  be  easily  located  externally.  The 
prominence  known  as  "Adam's  apple"  in  the  neck 
forms  its  upper  portion,  the  lower  border  being  about 
one  and  a  half  inches  below.  The  opening  into  the 
larynx  is  covered  with  a  little  leaf-shaped  piece  of 
cartilage  known  as  the  epiglottis,  which  aids  in  pre- 
venting food  and  other  foreign  substances  from  en- 
tering the  wind-pipe.  The  tongue  also  aids  in  this 
protection,  for  in  the  act  of  swallowing,  the  base  of  the 
tongue  is  carried  backward  and  partly  covers  the  open- 
ing of  the  larynx. 

The  trachea,  or  wind-pipe,  is  a  continuation  of  the 
larnyx  in  the  form  of  a  tube  about  four  or  five  inches 
long,  and  three-quarters  of  an  inch  to  an  inch  in 
diameter.  It  is  composed  of  rings  of  cartilage,  fibrous 
membrane  and  a   small   amount  of   muscular  tissue. 


THE  VITAL  PROCESSES  33, 

These  rings  have  the  same  function  as  the  cartilage 
which  forms  the  larnyx,  i.  e.,  to  keep  the  walls  sepa- 
rated or  the  tube  open  at  all  times.  The  trachea  di- 
vides into  two  branches  known  as  the  right  and  left 
bronchi. 


Fig.  7. — Showing  the  relative  position  of  heart  and  lungs  in  the 
cavity  of  the  chest. 


Upon  entering  the  lungs,  the  bronchi  further  divide 
and  subdivide  until  the  parts  become  exceedingly  small 
and  end  in  little  pouches  known  as  vesicles,  or  ''air 
cells."  It  is  interesting  to  note  that  in  the  division  of 
the  trachea  into  two  branches,  the  one  on  the  right  is 
somewhat  larger  than  the  one  on  the  left  and  appears. 


34  GOOD  HEALTH 

to  be  the  continuation  of  the  trachea.  It  is  for  this 
reason  that  small  articles  accidentally  sucked  into  the 
air  passages  are  more  often  found  in  the  right 
bronchus. 

The  respiratory  tract  is  lined  throughout  with  mu- 
cous membrane  which  is  kept  moist  and  prevents  fric- 
tion during  the  passage  of  air  through  the  tube.  The 
construction  of  this  membrane  in  the  upper  portion  is 
very  peculiar  and  extremely  interesting,  for  upon  its 
surface  are  found  little  hair-like  processes  which  are 
constantly  waving  towards  the  outer  world.  This  is 
of  valuable  aid  in  preventing  the  entrance  into  the  lungs 
of  dust  and  other  irritating  particles. 

The  lungs  are  two  pyramidal-,  cone-  or  triangular- 
shaped  organs  situated  in  the  chest  with  the  base  be- 
low and  longer  behind  than  in  front.  Each  lung 
weighs  about  twenty  ounces,  the  right  being  a  little 
heavier  than  the  left.  They  are  divided  by  deep  fis- 
sures into  lobes  or  sections,  the  right  lung  having  three 
lobes  and  the  left  two.  The  small,  or  upper,  portion 
or  apex  extends  to,  or  just  above,  the  clavicle  or  collar 
bone;  the  larger,  or  lower,  portion  or  base  descends 
in  front  to  the  sixth  rib ;  the  side  to  the  eighth,  and 
the  back  to  the  tenth.  The  lungs  are  surrounded  by 
a  closed  sac  lined  with  a  serous  membrane  called 
the  pleura,  similar  to  the  pericardium  covering  the. 
heart  and  possessing  the  same  functions,  i.  e.,  fur- 
nishing protection  and  preventing  friction.  This  sac 
or  membrane  frequently  becomes  inflamed  by  dis- 
ease or  accident:  the  condition  is  known  as  pleu- 
risy. 


THE  VITAL  PROCESSES  35 

The  lungs  are  composed  of  millions  of  minute 
pouches  or  air  cells  about  one-two  hundredths  of  an 
inch  in  diameter.  They  have  already  been  referred  to 
as  the  termination  of  the  bronchial  tubes.  The  enor- 
mous surface  represented  by  these  little  pockets,  which 
receive  the  air  taken  in  with  respiration,  would,  if 
spread  out,  cover  an  area  of  about  six  hundred  square 
feet.  The  walls  of  the  air  cells  and  the  capillaries 
surrounding  them  are  so  exceedingly  thin  that  the 
interchange  of  gases  and  other  products  between  the 
blood  and  the  inspired  air  readily  takes  place.  Under 
ordinary  conditions  we  breathe  from  sixteen  to  twenty 
times  each  minute. 

During  inspiration  the  air  is  carried  into  the  lungs 
by  the  descent  of  the  diaphragm,  which  exerts  a 
suction  force  as  it  is  carried  downward,  and  also  by 
the  elevation  of  the  ribs  which  increases  the  size  of 
the  chest.  Expiration,  or  the  expulsion  of  air  from 
the  lungs,  is  effected  by  the  elevation  of  the  diaphragm' 
and  the  descent  of  the  ribs  and  a  partial  collapse  of 
the  lung.  Although  these  are  the  principal  agents  of 
expiration,  there  are  other  elements,  notably  the  ac- 
tion of  certain  muscles  which,  although  of  lesser  im- 
portance, render  valuable  aid  when  there  is  great  diffi- 
culty in  breathing,  as  in  certain  affections  of  the  lungs. 
Then  the  action  of  muscles  about  the  neck  and  shoul- 
ders becomes  very  apparent. 

The  diaphragm  is  a  muscular  partition  which  sep- 
arates the  contents  of  the  chest  from  the  abdominal 
organs.  Above  the  diaphragm  are  found  the  heart  and 
lungs,  and  below,  the  stomach,  liver,  intestines  and 


26  GOOD  HEALTH 

other  abdominal  contents.  Its  function  is  very  im- 
portant both  in  connection  with  respiration  and  di- 
gestion. 

The  lungs  during  life  are  never  completely  collapsed. 
Complete  collapse  is  prevented  by  about  one  hundred 
cubic  inches  of  air,  which  cannot  be  expelled,  called 
''residual"  air.  Another  hundred  cubic  inches  known 
as  ''reserve"  air  usually  remain  in  the  lungs  after  ex- 
piration, and  are  used  during  increased  physical  exer- 
tion as  in  running,  rowing,  etc.  The  "tidal"  air  repre- 
sents the  amount  taken  into  the  lungs  at  each  ordinary 
inspiration,  and  consists  of  about  thirty  cubic  inches. 
During  violent  exercise,  however,  an  additional  hun- 
dred cubic  inches  may  be  taken  into  the  lungs  at  each 
inspiration.  This  is  known  as  "complemental"  air. 
The  extreme  capacity  of  the  lungs  would  therefore  be 
the  sum  of  the  residual,  reserve,  tidal  and  comple- 
mental air,  amounting  to  three  hundred  and  thirty 
cubic  inches.  The  vital,  or  respiratory,  capacity,  how- 
ever, is  the  amount  which  can  be  breathed  out  after 
the  deepest  possible  expiration,  and  would  therefore 
not  include  the  residual  air. 

DIGESTION 

The  alimentary  tract,  or  canal,  comprises  the  several 
structures  or  organs  through  which  food  and  drink 
enter  the  body  to  be  digested  and  absorbed. 

The  alimentary  tract  is  nearly  thirty  feet  long.  It 
b)egins  at  the  mouth  and  continues  through  the  pharynx, 
or  throat;  the  esophagus,  or  gullet;  the  stomach,  and 
the  small  and  large  intestines,  the  latter  terminating 


THE  VITAL  PROCESSES 


37 


at  the  external  opening,  or  anus.  These  structures  will 
be  spoken  of  in  their  order  from  above  down- 
wards. 

Mastication  is  the  first  step  in  digestion.    This  takes 
place  in  the  mouth,  the  most  important  agents  involved 


Fig.  8. — The  jaws  and  the  teeth,  i,  2,  incisors;  3,  canines;  4,  5, 
bicuspids;  6,  7,  8,  molars;  a,  vein;  b,  artery;  c,  nerve;  d,  vein, 
artery,  and  nerve. 


being  the  teeth.  In  man  these  are  so  fashioned  and 
arranged  that  food  may  be  cut,  torn  and  ground,  the 
teeth  for  each  process  being  respectively  incisors^ 
canines   and   molars,   or  grinders.      Their    formation 


38 


GOOD  HEALTH 


shows  that  man  is  adapted  to  all  sorts  of  food.  Among 
the  animals,  the  cow,  for  instance,  which  obtains  its 
food  principally  by  grazing,  has  well  developed  molars 
or  grinders ;  while  dogs,  or  animals  that  depend  prin- 
cipally upon  meat  for  sustenance,  have  sharp  or  tusk- 


FiG.  9. — Salivary  glands. 


like  teeth  called  ''canines,"  which  enable  them  to  tear 
meat  from  the  bone. 

The  teeth  are  inserted  along  the  edges  of  the  alveolar 
processes  of  the  superior  and  inferior  maxillary  bones, 
or  upper  and  lower  jaw  bones.  There  are  thirty-two 
teeth  in  all,  sixteen  in  each  jaw,  arranged  as  shown  in 
the  diagram  (Fig.  8).  The  portion  of  a  tooth  pro- 
jecting beyond  the  gum  is  called  the  crown ;  the  rest  is 
imbedded  in  the  bone.     The  crown  is  covered  with 


THE  VITAL  PROCESSES  39 

enamel,  the  hardest  structure  of  the  body,  which  pro* 
tects  the  teeth  against  various  destructive  agents  and 
prevents  too  rapid  wear  as  the  result  of  friction  dur~ 
ing  mastication. 

The  teeth  cut  and  grind  the  food  so  that  all  parts 
of  it  can  be  exposed  to  the  digestive  fluid.  When  food 
is  introduced  into  the  mouth,  it  is  made  soft  and  wet 
by  an  alkaline  secretion  known  as  saliva  or  ''spittle" 
which  is  secreted  by  three  glands,  the  parotid,  the 
submaxillary  and  the  sublingual,  which  discharge  their 
contents  into  the  mouth  through  small  ducts  or  tubes. 
The  flow  of  saliva  may  be  stimulated  by  the  anticipa- 
tion of  palatable  food,  i.  e.,  through  a  mental  influence. 
The  parotid,  the  largest  of  the  three  glands,  is  situated 
behind  the  angle  of  the  jaw.  The  characteristic  de- 
formity or  swelling  below  and  in  front  of  the  ears  in 
the  disease  known  as  ''mumps,"  is  due  to  the  enlarge- 
ment of  these  glands.  The  secretion  of  the  parotid 
accomplishes  mainly  the  moistening  of  the  food;  the 
submaxillary  and  sublingual  secretion  is  more  viscid 
or  "slippery"  and  greatly  facilitates  the  passage  of  the 
food  downwards.  In  reptiles  where  there  is  no  mas- 
tication, it  is  this  slimy  secretion  that  enables  them  to 
swallow  substances  of  a  very  large  bulk;  by  this  means 
a  comparatively  small  snake  is  able  to  swallow  a  good- 
sized  rat.  Saliva  also  renders  important  aid  in  diges- 
tion by  changing  starch  into  sugar,  the  form  in  which 
it  is  taken  into  the  system. 

If  food  is  not  properly  masticated  the  digestive  ap- 
paratus sooner  or  later  is  sure  to  suffer,  and  indirectly, 
serious  results  may  follow.    Therefore,  the  importance 


40  GOOD  HEALTH 

of  giving  proper  and  early  care  to  the  teeth  cannot  be 
overestimated. 

The  pharynx,  or  throat,  is  a  continuation  of  the 
mouth  and  has  no  special  digestive  action. 

The  esophagus,  or  gullet,  is  a  muscular  tube  about 
eight  or  nine  inches  long  which  is  collapsed  when  not 
functioning.  It  begins  at  the  lower  border  of  the  phar- 
ynx and  passes  downward  through  an  opening  in  the 
diaphragm  and  becomes  continuous  with  the  upper,  or 
cardiac,  end  of  the  stomach.  This  tube  accelerates  by 
its  muscular  action  the  passage  of  food  downward  to 
the  stomach.  Were  it  not  for  its  muscular  coat,  swal- 
lowing, or  deglutition,  would  be  practically  impossible. 
Difficulty  in  this  direction  sometimes  occurs  when  the 
nerve  supply  in  this  tissue  is  interfered  with.  When 
one  eats  too  rapidly,  particularly  of  food  which  is  dry 
and  has  not  been  properly  masticated,  it  is  difficult  for 
the  esophagus  for  the  moment  to  force  the  food  down- 
ward. The  common  phrase,  "stuck  in  the  throat,"  in- 
dicates the  discomfort  which  occurs  in  this  condition. 
For  many  reasons  it  is  necessary  that  we  should  eat 
slowly  and  thoroughly  masticate  our  food. 

The  stomach  is  one  of  the  principal  organs  of  diges- 
tion. It  resembles  a  bag-pipe  in  appearance,  having  a 
greater  and  lesser  curvature.  It  lies  crosswise  in  the 
abdominal  cavity  below  the  diaphragm,  but  when  dis- 
tended with  food,  its  position  is  materially  changed. 
It  has  two  openings,  one  on  the  left  side  continuous 
with  the  lower  end  of  the  esophagus  already  referred 
to,  and  called  the  cardiac  opening  from  its  proximity 
to  the  heart,  and  the  other  on  the  right  side  connected 


THE  VITAL  PROCESSES 


41 


with  the  small  intestines.  This  opening  is  guarded  by 
a  valve-like  constriction  called  the  pylorus  or  "gate 
keeper,"  which  aids  in  preventing  food  from  return- 
ing to  the  stomach,  although  in  certain  conditions  this 
m.ay  occur. 

The  stomach  is  ten  to  twelve  inches  long,  about  five 
inches  in  diameter  and  weighs  something  over  four 


imm.;!iirl!ii!!V-,ViJ„!.|  M'  ,1    '      ■  \  ;^  , 


I 


Fig.   10. — The  stomach. 


ounces.  Its  capacity  is  from  five  to  eight  pints.  In 
a  newborn  child  it  holds  about  one  ounce.  The  stom- 
ach is  composed  of  three  coats  or  layers :  the  external, 
Hhroserous ;  the  middle,  muscular;  and  the  internal, 
mucous  coat.  The  external  covering  supplies  strength 
and  prevents  friction  during  the  movement  of  the 
stomach.  The  muscular  coat,  composed  of  involun- 
tary muscle  fibers,  furnishes  the  movement  neces- 
sary for  the  proper  digestion  of  food,  for  it  manipu- 
lates the  stomach  so  that  the  food  may  be  freely  ex- 
posed  to    the   gastric   juice.      The   internal   coat,   or 


42  GOOD  HEALTH 

mucous  membrane,  is  the  most  important  layer  of  the 
stomach,  for  in  the  substance  of  this  membrane  are 
found  innumerable  little  glands  which  open  upon  its 
surface.  These  are  known  as  ''peptic"  or  "gastric" 
glands,  and  secrete  the  gastric  juice  necessary  to  di- 
gestion. When  food  enters  the  stomach,  or  even  at 
the  beginning  of  mastication,  the  contents  of  these 
glands  appear  on  the  surface  of  the  membrane,  and 
the  muscular  coat  begins  its  slow  and  worm-like  con- 
traction to  bring  the  food  into  contact  with  this  secre- 
tion. The  food  is  then  changed  in  character  and  be- 
comes a  uniform  mass,  some  of  which  is  absorbed  by 
the  capillary  blood-vessels  of  the  stomach ;  the  greater 
part,  however,  passes  into  the  small  intestines  for 
further  digestion  and  absorption. 

The  stomach  is  collapsible  when  empty,  but  when 
full  lies  against  the  abdominal  walls  and  presses  up- 
ward against  the  diaphragm,  and  in  this  manner  often 
interferes  with  the  action  of  the  heart  and  lungs.  The 
distress  which  commonly  occurs  after  a  full  meal  is 
usually  due  to  this  cause. 

The  gastric  juice,  of  which  about  fourteen  pints  are 
secreted  in  twenty-four  hours,  is  an  acid  secretion, 
differing  from  all  other  digestive  fluids,  which  are 
alkaline. 

The  small  intestine  is  also  a  very  important  organ 
of  digestion.  It  begins  at  the  pyloric,  or  right,  ex- 
tremity of  the  stomach,  and  is  a  tube  about  twenty 
feet  long  and  one  inch  in  diameter  and  is  composed  of 
three  coats  similar  to  the  stomach.  Although  there  is 
no  line  of  demarcation,  anatomists  have  for  certain 


THE  VITAL  PROCESSES  43 

reasons  divided  the  small  intestine  into  three  portions, 
the  first,  or  duodenum,  being  the  shortest  portion — 


Fig.  II. — Position  of  abdominal  contents. 

about  eight  inches   long.     The   second   is   called  the 
jejunum,  and  the  last  portion  is  known  as  the  ileum. 
The  jejunum  is  generally  empty  after  death  and  re- 
ceives its  name  from  this  fact.     In  the  mucous  mem- 


44  GOOD  HEALTH 

brane  of  the  intestine  are  found  glands  yielding  an 
alkaline  secretion  which  plays  an  exceedingly  import- 
ant part  in  digestion.  For  instance,  while  meats  are 
broken  up  and  dissolved  by  the  gastric  juice,  they  are 
digested  and  absorbed  in  the  small  intestine. 

The  large  intestine  is  about  five  feet  long  and  twice 
the  diameter  of  the  small  intestine.  It  begins  on  the 
right  side  of  the  body  and  is  divided  into  three  por- 
tions: the  ascending,  the  transverse  and  the  descend- 
ing colon.  The  lower  part  of  the  last  is  called  the  rec- 
tum and  terminates  at  the  external  opening,  or  anus. 
The  small  intestine  is  continuous  with  the  lower  por- 
tion of  the  ascending  colon.  The  digestive  power  of 
the  large  intestine  is  very  feeble  and  unimportant;  it 
is  rather  a  temporary  receptacle  for  undigested  food 
and  refuse  matter  which  is  to  be  discharged  from  the 
body.  The  transverse  colon,  which  crosses  the  center 
of  the  abdomen  about  on  the  level  with  the  navel, 
frequently  becomes  irritated  by  an  accumulation  of 
waste  matter,  and  is  the  seat  of  intense  pain  known  as 
"colic." 

The  appendix,  the  inflammation  of  which,  known  as 
appendicitis,  is  familiar  to  the  public,  is  a  small  tube 
about  two  or  three  inches  long  and  about  a  quarter  of 
an  inch  in  diameter,  given  off  from  the  lower  end  of  the 
ascending  colon.     Its  function  is  not  known. 

The  liver  is  the  largest  organ  of  the  body.  It  is 
situated  in  the  abdominal  cavity  below  the  diaphragm 
and  above  the  stomach,  principally  on  the  right  side, 
its  longest  diameter  being  from  right  to  left.  This 
organ,  moderately  filled  with  blood,  weighs  about  four 


THE  VITAL  PROCESSES 


45 


pounds.  The  surfaces  of  the  liver  are  smooth  and  dark 
brown.  In  its  normal  healthy  condition  it  extends 
downward  on  the  right  side  as  far  as  the  lower  border 
of  the  ribs.  Under  certain  conditions,  however,  such 
as  tight  lacing,  it  may  be  pressed  below  this  point. 


Fig.  12. — Under  surface  of  the  liver,  showing  the  gall-bladder  and  a 
section  of  blood-vessels. 


The  liver  has  three  distinct  and  separate  functions: 
First,  it  renders  very  important  aid  to  digestion 
through  a  certain  secretion  known  as  bile.  It  also  pro- 
duces sugar  which  subsequently  becomes  changed 
chemically  and  helps  to  generate  the  body  heat.  Finally 
it  removes  a  small  amount  of  waste  matter  from  the 
system ;  in  other  words,  it  excretes  as  well  as  secjretes. 


46 


GOOD  HEALTH 


The  bile  is  discharged  through  a  small  tube  into  the 
first  portion  of  the  small  intestine,  the  duodenum. 

On  the  under  surface  of  the  liver  is  found  a  pouch 
about  four  inches  long  and  one  inch  in  width,  called 
the  gall-bladder.  This  acts  as  a  reservoir  for  the 
bile,  the  flow  being  continuous. 

The  pancreas,  or  ''belly  sweetbreads,"  compared 
with  the  liver  is  a  very  small  gland,  being  about  six 


Fig.  13. — The  pancreas,  partly  cut  away,  so  as  to  show  the  duct 
which  collects  the  pancreatic  juice  and  empties  it  into  the  duo- 
denum. 


inches  long  and  one  inch  in  thickness,  but  it  has  an 
exceedingly  important  function.  It  is  located  at  tlie 
upper  and  back  part  of  the  abdominal  cavity,  mainly 
on  the  left  side  and  behind  the  stomach.  It  secretes 
an  alkaline  fluid  called  the  pancreatic  juice,  which  is 
discharged  through  a  small  tube  into  the  duodenum 
where  the  bile  is  also  received,  at  which  point  these 
two  important  secretions  act  together.  The  chief 
function  of  the  pancreatic  juice  is  to  prepare  the  oil 
and  fat  contained  in  the  food  for  absorption  by  the 
process  known  as  ''emulsification."    During  this  trans- 


THE  VITAL  PROCESSES  47 

formation  the  oil  and  fat  of  the  food  are  converted 
into  a  whitish  fluid  called  ''chyle,"  which  is  absorbed 
by  the  lymphatic  vessels  that  follow  along  the  intes- 
tinal tract.  They  are  called  lacteals,  or  milk  carriers, 
on  account  of  their  color  when  filled  with  chyle. 
These  empty  into  a  pouch  located  in  the  lower  part 
of  the  back,  from  which  point  the  chyle  is  carried 
through  a  tube,  the  thoracic  duct,  to  a  large  vein  on 
the  upper  left  side  of  the  chest,  and  in  this  way 
reaches  the  circulation  and  forms  a  necessary  element 
of  nutrition.  In  addition  to  the  above,  the  pancreatic 
juice  has  an  all-round  function  in  digestion,  and  as- 
sists other  digestive  fluids  in  their  work. 


KIDNEYS 

The  kidneys  are  excretory  organs.  They  consist  of 
two  large,  bean-shaped  glands  situated  at  the  back  of 
the  abdominal  cavity  on  each  side  of  the  spinal 
column,  extending  from  the  eleventh  rib  downward 
nearly  to  the  upper  portion  of  the  pelvis,  the  right 
kidney  being  a  little  below  the  left.  They  are  about 
four  inches  in  length  and  two  in  width  and  weigh 
from  four  to  six  ounces  each. 

The  kidneys  are  constructed  of  tubes  which  may 
be  called  waste  pipes,  for  their  purpose  is  to  drain  oif 
from  the  blood  refuse  and  poisonous  matter  consisting 
largely  of  worn  out  tissue.  The  fluid  excreted  by 
these  organs  is  known  as  urine,  and  consists  of  water 
holding  in  solution  the  various  products  just  referred 
to,  the  principal  one  being  known  as  urea.     If  this  is 


48  GOOD  HEALTH 

not  promptly  removed  from  the  body  serious  or  fatal 
results  follow.  This  usually  occurs  in  the  advanced 
stages  of  kidney  disease.  The  amount  of  urine  ordi- 
narily discharged  from  the  body  in  twenty-four  hours 
is  about  three  pints,  although  this  is  subject  to  great 
change,  depending  upon  climatic  conditions  and  vari- 
ous organic  and  functional  affections. 

The  urine  passes  from  the  kidneys  to  the  bladder 


Fig.  14. — Vertical  section  of  a  kidney,  showing  the  minute  tubes 
which  excrete  the  urine;  also  the  pelvis,  or  basin  of  the  kidney, 
which  receives  the  urine  before  it  passes  downward  to  the  blad- 
der.    The  beginning  of  a  ureter  is  also  shown. 


THE  VITAL  PROCESSES  49 

through  two  small  tubes,  one  for  each  kidney  about 
the  size  of  a  goose-quill,  and  sixteen  to  eighteen  inches 
long;  these  are  known  as  ureters.  Small  concretions 
from  the  kidneys,  popularly  known  as  "gravel,"  vary- 
ing in  size  from  a  grain  of  sand  to  larger  dimensions, 
often  pass  through  these  tubes  to  the  bladder,  usually 
causing  intense  pain. 

The  bladder  or  reservoir  which  receives  the  urine 
is  situated  in  the  lower  part  of  the  pelvic  cavity  in 
front,  and  is  a  sac  or  pouch  having  three  coats  or  lay- 
ers similar  to  the  layers  of  the  stomach  and  intestines. 
When  moderately  distended  the  bladder  is  about  five 
by  three  inches,  and  usually  contains  about  one  pint, 
although  it  may  hold  considerably  more.  The  mus- 
cular coat,  consisting  of  involuntary,  or  unstriped, 
muscle  fibers,  is  the  principal  factor  in  expelling  the 
urine,  although  this  may  be  aided  by  the  action  of  the 
powerful  abdominal  muscles  which  are  under  the  con- 
trol of  the  will. 

SKIN 

The  skin  covers  all  portions  of  the  body  and  pro- 
tects the  deeper  parts,  and  aids  in  giving  grace  and 
symmetry  to  the  body.  Like  the  liver,  it  is  an  organ 
of  secretion  and  excretion,  its  principal  function  be- 
ing similar  to  that  of  the  kidneys.  It  also  contains  the 
sense  of  touch,  which  is  highly  developed  at  the  finger 
ends.  Contrary  to  general  belief,  the  power  of  ab- 
sorption through  the  unbroken  skin  of  the  human  be- 
ing is  extremely  slight. 

The  skin  is  composed  of  two  layers,  the  outer  and 


50  GOOD  HEALTH 

inner.  The  outer  is  known  as  the  epidermis,  false  or 
scarf  skin;  the  inner  receiving  the  name  of  derma  or 
true  skin.  The  epidermis  contains  neither  blood- 
vessels nor  nerves,  and  is  simply  a  scaly  layer  which 
protects  the  true  skin  underneath,  and  becomes  easily 
detached  from  it  under  certain  abnormal  conditions. 
A  sunburn  will  show  the  separation  of  these  layers 
often  with  a  small  amount  of  fluid  between  them 
which  constitutes  a  blister.  The  derma,  or  true  skin, 
is  richly  supplied  with  blood-vessels  and  lymphatics. 

The  true  skin  contains  millions  of  minute  suderif- 
erous,  or  sweat,  glands,  sebaceous,  or  fat,  glands  and 
hair  follicles.  The  sweat  glands,  like  the  ducts  in  the 
kidneys,  are  constantly  removing  from  the  body  a 
watery  vapor  known  as  perspiration  or  "sweat,"  an 
excretion  which  by  rapid  evaporation  from  the  sur- 
face has  largely  to  do  with  the  regulation — usually 
reduction — of  the  body  temperature.  This  wonder- 
ful activity  of  the  skin  and  the  large  quantity  of  per- 
spiration thrown  off  and  rapidly  evaporated  enable 
one  to  endure  a  very  high  degree  of  heat. 

In  addition  to  the  action  just  described,  the  sweat 
glands  eliminate  from  the  system  waste  matter  simi- 
lar to  that  excreted  by  the  kidneys,  chiefly  urea.  For 
this  reason  the  skin  is  regarded  somewhat  as  a  sup- 
plementary organ  to  the  kidneys,  and  they  relieve  each 
other.  In  warm  weather  when  the  skin  is  most  ac- 
tive, the  amount  of  perspiration  is  largely  increased, 
and  the  amount  of  urine  is  correspondingly  diminished, 
while  in  winter  the  condition  is  reversed.  About  two 
pints  of  perspiration  is  excreted  in  twenty-four  hours 


THE  VITAL  PROCESSES 


51 


in  temperate  weather,  although  this  may  be  largely 
increased,  for  it  is  subject  to  great  variations  depend- 
ing upon  the  outside  temperature,  exercise,  etc.  It  is 
very  important  that  the  similarity  of  function  of  the 
skin  and  kidneys  should  be  recognized,  for  when  one 
is  disabled,  the  other  may  to  a  certain  extent  perform 
its  work.  For  instance,  if  the  kidneys  are  impaired 
either  temporarily  or  permanently,  much  relief  may 
be  obtained  by  stimulating  the  skin.  Impairment  of 
the  function  of  either  of  these  organs  becomes  a  seri- 
ous matter  if  it  is  prolonged  or  if  one  does  not  quickly 
relieve  the  other.  Physiologists  have  proven  this  by 
shaving  and  varnishing  the  skin  of  animals ;  grave  or 
fatal  results  soon  follow.-    The  importance  of  keeping 


Sweat  pore 


Epidermiia 


Dennis 
Sweat  gland  |  -  - 


( j  / ,        Oil  glands 

WW)  ' } 


Fat  eel! 


Hair  bulb 


Blood-vessel  " 

Fig.  15. — Section  of  skin  greatly  magnified. 


.  52  GOOD  HEALTH 

the  skin  and  kidneys  in  a  good  healthy  condition  by 
a  proper  mode  of  living  is  apparent. 

The  product  of  the  fat,  or  sebaceous,  glands  which 
lie  close  to  and  discharge  their  contents  into  the  hair 
sheath,  or  follicle,  in  the  skin  is  a  secretion.  It  pro- 
tects and  keeps  the  skin,  as  well  as  the  hair,  in  an  oily 
and  pliable  condition.  With  few  exceptions,  the  hair 
follicles  cover  the  surface  of  the  body,  although  in 
some  portions  it  is  so  fine  that  it  is  hardly  noticeable. 
The  hair  and  nails  are  for  the  purpose  of  protection 
and  are  regarded  as  appendages  of  the  skin;  they  re- 
ceive their  nourishment  by  absorption. 

The  experience  of  "hair  standing  on  end'*  is  not 
entirely  a  fancy,  for  attached  to  the  sheath,  or  folli- 
cle, which  conducts  the  hair  to  the  surface  of  the 
skin  are  involuntary  muscle  fibers  which,  when  for- 
cibly contracted,  raise  the  hair  to  a  more  erect  posi- 
tion. This  contraction  may  be  brought  about  by  men- 
tal stimulus,  such  as  fright,  etc. 

SPLEEN 

The  spleen  is  a  soft  and  spongy  organ  situated  in 
the  abdominal  cavity  on  the  left  side  near  the  stomach, 
and  extends  from  the  ninth  to  the  eleventh  rib.  It 
measures  about  five  inches  long,  three  inches  wide  and 
two  inches  thick  and  weighs  about  eight  ounces.  It 
is  called  a  ductless  gland,  not  having  the  characteris- 
tic of  either  a  secretory  or  excretory  organ.  Its  func- 
tion has  not  yet  been  definitely  settled,  although  it  is 
not  absolutely  essential  to  life,  for,  as  a  surgical  neces- 
sity, it  has  been  removed  from  the  body  with  recovery 


THE  VITAL  PROCESSES  53 

of  the  patient.  Under  certain  conditions  it  becomes 
inflamed  and  enlarged;  for  instance,  in  malaria  the 
spleen  becomes  very  much  increased  in  size,  and  in 
sections  of  the  world  where  this  disease  is  prevalent 
the  enlargement,  which  is  quite  apparent,  is  referred  to 
as  "ague  cake,"  the  term  ague  meaning  malarial  fever. 

NERVOUS    SYSTEM 

The  activity  of  the  mind  and  body,  the  harmonious 
working  of  the  several  organs,  and  the  sympathy  exist- 
ing between  the  different  parts  of  the  body  depend 
upon  the  nervous  system  which  is  divided  into  the 
cerebrospinal  axis,  or  central  nervous  system,  and  the 
sympathetic  system. 

The  cerebrospinal  axis  comprises  the  brain,  the 
spinal  cord  and  the  nerves. 

The  brain,  which  is  the  seat  of  the  intellect,  the  will 
and  the  emotions,  is  contained  in  the  cranial  cavity. 
It  is  divided  into  four  principal  parts :  the  cerebrum, 
cerebellum,  the  pons  Varolii  and  the  medulla  oblongata. 

The  cerebrum  constitutes  about  four-fifths  of  the 
entire  brain.  It  is  egg-shaped  or  oval  in  form  and 
is  divided  into  two  portions  by  a  deep  groove  running 
from  the  front  backward.  It  is  composed  of  gray  mat- 
ter and  white  matter  and  is  about  the  consistence  of 
sweetbreads.  The  white  matter  forms  the  internal  and 
greater  portion  of  the  cerebrum,  the  gray  matter  form- 
ing the  external  layer.  The  surface  of  the  cerebrum  is 
not  smooth,  but  is  thrown  into  deep  folds  called  con- 
volutions ;  this  arrangement  increases  its  area,  and 
consequently  its  function.    These  convolutions  are  not 


Fig.  1 6. — The  cerebrospinal  system  of  nerves. 
54 


THE  VITAL  PROCESSES  55 

well  marked  in  the  brain  of  an  infant,  but  grow  deeper 
and  larger  until  this  organ  has  practically  reached  its 
full  development  at  about  the  fortieth  year.  The 
deep  convolutions  referred  to  are  characteristic  of  the 


Fig.  17. — Side  view  of  the  brain. 

human  brain;  they  are  present  in  a  far  less  degree  in 
the  lower  animals. 

The  cerebrum  is  the  seat  of  the  mind  and  its  func- 
tions which  distinguish  man  from  the  lower  animal. 
The  exact  points  in  the  cerebrum  where  these  vari- 
ous functions  are  located  have  not  yet  been  fully 
determined,  although  there  is  no  doubt  that  they  are 
connected  with  the  gray  matter. 

The  cerebellum,  or  little  brain,  corresponds  in  struc- 
ture closely  to  the  cerebrum  with  which  it  is  connected, 
being  situated  beneath  it  and  at  the  back  part  of  the 


56 


GOOD  HEALTH 


cranial  cavity.  The  cerebellum  regulates  and  keeps 
in  perfect  harmony  the  different  movements  of  the 
body,  particularly  the  extremities. 


Cerebrum. 


Pons  Varolii, 


Medulla 
oblongata. 


Cerebellum. 


Fig.  1 8. — Under  surface  of  brain,  showing  the  cerebrum,  cerebellum, 
pons  Varolii,  and  medulla  oblongata. 

The  pons  Varolii,  or  "bridge,"  is  the  small  portion 
of  the  brain  situated  in  front  of  the  cerebellum;  it 
binds  together  the  different  parts  of  the  brain  already 
enumerated,  and  also  transmits  the  different  nerves 
passing  between  the  brain  and  the  spinal  cord. 


THE  VITAL  PROCESSES  57 

The  medulla  oblongata  is  beneath  the  pons  Varolii, 
and  appears  to  be  the  upper  end  of  the  spinal  cord 
somewhat  extended.  In  the  substance  of  the  inedulla, 
nerves  which  supply  motion,  passing  from  the  brain 
to  the  spinal  cord,  cross  each  other,  or  decussate.  Con- 
sequently, a  motor  nerve  fiber  having  its  origin  in 
the  right  side  of  the  brain  crosses  to  the  left  when  it 
reaches  the  medulla,  and  therefore  becomes  identified 
with  the  left  side  of  the  spinal  cord  from  which  point 
it  supplies  motion  to  the  same  side  of  the  body.  This 
will  explain  why  a  hemorrhage  on  one  side  of  the 
brain  will  produce  paralysis  on  the  opposite  side  of 
the  body,  as  in  apoplexy.  The  medulla  also  presides 
over  the  function  of  respiration. 

The  human  brain  weighs  about  fifty  ounces,  being 
heavier  than  that  of  any  lower  animal,  with  the  ex- 
ception of  the  elephant  and  the  whale. 

The  spinal  cord  is  that  portion  of  the  central  ner- 
^^ous  system  contained  in  the  spinal  or  vertebral  col- 
umn. The  cord  is  cylindrical  in  shape,  extending 
downward  from  the  brain  to  the  first  lumbar  vertebra ; 
it  is  from  fifteen  to  eighteen  inches  long.  Through  its 
branches  it  transmits  nerve  impulses  to  and  from  the 
brain.  It  is  to  a  certain  extent  capable  of  acting  as  a 
separate  nerve  center  and  generating  force  independ- 
ently of  the  brain,  as  far  as  motion  and  sensation  are 
concerned,  but  not  special  sense. 

Nerves  are  classified  as  those  having  a  motor  in- 
fluence, those  having  sensory  influence,  and  nerves  of 
special  sense. 

Motor  nerves   are   fibers  which  conduct  from  the 


58  GOOD  HEALTH 

brain,  and  to  a  certain  extent  from  the  spinal  cord,  the 
force  necessary  to  animate  muscular  fiber,  thus  pro- 
ducing the  different  movements  of  the  body.  Motor 
nerves,  therefore,  transmit  an  influence  from  within 
outward.  If  wt  desire  to  walk,  the  mind  wills  that 
certain  muscles  shall  be  put  into  action ;  this  communi- 
cation is  transmitted  from  the  brain  through  the  motor 
nerves  in  the  spinal  cord  to  the  muscles.  In  the  ordi- 
nary movement  of  the  body  we  do  not  direct  the  ac- 
tion of  each  muscle,  for  this  is  done  mechanically; 
but  the  mind  starts  and  stops  the  machine  and  directs 
its  course. 

Sensory  nerves  are  fibers  which  convey  sensations 
from  the  different  portions  of  the  body  to  the  brain 
from  without  inward.  For  instance,  when  a  finger  is 
burned  or  injured,  the  sensation  of  the  pain  experi- 
enced indicates  the  impression  made  upon  the  sensory 
nerve  at  the  point  of  injury  and  communicated  to 
the  great  nerve  center  or  brain. 

There  are  thirty-two  nerves  given  off  from  each 
side  of  the  spinal  cord,  forming  thirty-two  pairs.  Each 
pair  of  nerves  contains  motor  and  sensory  filaments  or 
fibers  which  are  distributed  to  the  body  to  perform 
the  function  already  described. 

Nerves  of  special  sense,  as  the  name  implies,  have 
a  separate  function  from  those  referred  to  above. 
They  do  not  transmit  motion  or  common  sensation, 
but  preside  over  the  special  senses,  such  as  sight,  hear- 
ing, taste,  etc.  Twelve  pairs  of  nerves  are  provided 
from  the  under  surface,  or  base,  of  the  brain  for 
this  purpose. 


THE  VITAL  PROCESSES  59 

The  central  nervous  system  controls  the  functions 
of  animal  life,  the  intellect,  general  sensation,  motion 
and  the  special  senses.  There  is  still  another  system 
comprising  the  sympathetic  nerves,  which  presides  over 
secretions  and  excretions,  the  proper  distribution  of 
blood  and  nourishment  to  the  tissues,  the  control  of 
the  involuntary  muscle  fibers  in  the  alimentary 
tract,  blood-vessels,  stomach,  bladder,  etc.  These  must 
be  unaffected  by  outer  conditions.  Were  they  sub- 
ject to  the  will  and  to  the  influence  that  governs  the 
cerebrospinal  axis,  the  functions  of  organic  life  would 
soon  be  disturbed  and  the  most  serious  consequences 
would  follow.  This  system  must  work  uninterruptedly 
in  health  and  disease  both  day  and  night  and  at  all 
times.  For  this  purpose,  nature  has  supplied  a  sepa- 
rate and  independent  nerve  force,  the  sympathetic,  or 
ganglionic,  system,  consisting  of  a  series  of  little  bod- 
ies or  ganglia  which  begin  at  the  under  surface  of  the 
brain  and  continue  downward  on  each  side  of  the 
spinal  column  to  its  lower  extremity.  Although  this 
system  is  independent  of  the  cerebrospinal  axis  and 
its  special  function,  it  communicates  with  and  accom- 
panies the  cranial  and  spinal  nerves  to  the  various 
organs.  In  this  manner,  the  sympathetic  system  brings 
the  different  organs  into  sympathetic  relation  with  each 
other.  This  relation  will  explain  why  a  disordered 
stomach  will  produce  headache  and  why  death  may 
follow  a  severe  blow  at  the  pit  of  the  stomach.  In  the 
latter  event  the  large  sympathetic  ganglion  at  the  back 
of  the  stomach  is  injured  and  the  shock  conveyed  to 
the  heart  is  sufficient  to  arrest  its  action. 


6o  GOOD  HEALTH     • 

LYMPHATIC  SYSTEM 

A  description  of  the  circulation  and  the  means  by 
which  nourishment  is  supplied  to  and  waste  matter  re- 
moved from  the  body  would  be  incomplete  without 
a  reference  to  the  lymphatic  or  absorbent  vessels.  It 
has  been  stated  in  an  early  part  of  this  chapter  that  the 
tissues  are  directly  nourished  by  the  minute  capillaries 
which  have  an  exceedingly  thin  coat  through  which 
the  fluid  portion  of  the  blood  containing  sustenance 
readily  escapes  into  the  surrounding  tissues.  After 
the  nourishment  is  extracted  much  fluid  remains 
and  were  it  not  quickly  removed  the  tissues  would  be 
overcharged  with  fluid  and  become  *'soggy."  It  is 
true  that  the  capillary  blood-vessels  reabsorb  some 
of  this  liquid  but  only  a  small  part  of  it;  therefore 
some  other  agent  for  this  purpose  is  necessary :  This 
is  the  function  of  the  lymphatic  vessels.  These  ves- 
sels begin  close  to  the  capillaries  and  coming  together 
form  larger  vessels  which,  with  the  exception  of  those 
draining  the  right  arm  and  the  right  side  of  the  face 
and  neck,  discharge  their  contents  into  a  common 
trunk  known  as  the  thoracic  duct.  The  thoracic  duct 
lies  in  front  of  the  vertebral  column  and,  passing  up- 
ward, discharges  its  contents  into  a  large  vein  on  the 
left  side  of  the  neck ;  this  empties  into  the  left  auricle 
of  the  heart.  The  lymphatics  from  the  right  arm  and 
right  side  of  the  face  and  neck  empty  into  a  cor- 
responding vein  on  the  right  side  of  the  neck. 

There  are  two  sets  of  lymphatics :  a  superficial  one 
just  under  the  skin,  and  one  which  drains  the  cavities 


THE  VITAL  PROCESSES  6i 

and  deeper  structures  of  the  body.  In  the  course  of 
the  lymphatics  and  intimately  connected  with  them 
are  found  small  bodies  of  varying  sizes  known  as 
lymphatic  glands.  These  have  a  very  important  func- 
tion ;  they  constitute  a  filter  or  trap  which  prevents  the 
passage  of  infectious  or  poisonous  matter  into  the 
system.  In  doing  this  they  often  become  inflamed  and 
enlarged  and  sometimes  a  surgical  operation  is  neces- 
sary. The  enlarged  glands  in  the  neck  which  accom- 
pany diphtheria  or  other  throat  affections  are  familiar 
to  all. 

In  describing  the  pancreas  it  was  stated  that  the 
fats  and  oils  taken  with  the  food  were  emulsified  by 
the  pancreatic  juice  and  transformed  into  a  product 
resembling  milk  and  known  as  **chyle."  This  is  also 
taken  up  by  the  intestinal  lymphatics  and  carried  to 
the  thoracic  duct  and  thence  to  the  general  circula- 
tion for  nourishment.  It  will  thus  be  seen  that  the 
principal  function  of  the  lymphatics  is  to  return  to 
the  circulation  fluid  which  was  removed  during  the 
process  of  nourishment. 


CHAPTER  III 


AIR 


We  live  in  a  sea  of  air  or  atmosphere  which  sur- 
rounds the  earth  to  a  depth  of  many  miles.  The  com- 
position of  this  aeriform  envelope  was  unknown  until 
about  the  middle  of  the  eighteenth  century,  when  the 
researches  of  Joseph  Priestley,  an  English  chemist,  led 
to  the  discovery  that  air  consists  chiefly  of  oxygen  and 
nitrogen.  It  was  subsequently  found  that  a  very  small 
amount  of  carbon  dioxid,  commonly  known  as  carbonic 
acid,  forms  part  of  the  atmosphere.  The  following  are 
the  proportions :  nitrogen,  over  79  per  cent ;  oxygen, 
over  20  per  cent,  and  carbon  dioxid,  less  than  i  per 
cent.  These  gases  exist  in  the  air  as  a  mechanical,  and 
not  a  chemical,  compound.  In  addition,  a  varying 
amount  of  moisture  is  always  found  in  the  atmosphere. 

Air  also  contains  impurities,  either  gases  or  solids, 
which  differ  in  character  and  amount  according  to  the 
locality,  the  purest  air  being  found  at  sea  and  in  the 
mountainous  regions. 

The  composition  of  air  and  the  fact  that  the  propor- 
tion of  the  gases  which  compose  it  is  subject  to  very 
little  change  call  for  more  than  passing  notice.  It  is 
with  oxygen  we  are  chiefly  concerned,  for  of  this  we 
must  have  a  constant  supply  to  maintain  our  existence. 

62 


AIR  63 

Oxygen  is  far  too  stimulating  to  be  used  alone,  for 
under  this  condition  we  would  soon  be  worn  out  from 
overexcitement.  Therefore,  nature  dilutes  it  with  ni- 
trogen, a  very  bland  and  inactive  gas.  For  this  reason 
it  is  of  great  importance  that  the  normal  proportion  of 
gases  composing  the  air  should  remain  undisturbed. 

Carbon  dioxid  is  found  even  in  the  purest  air.  This 
gas  is  the  result  of  innumerable  forms  of  decay  upon 
the  earth's  surface,  and  also  within  the  earth.  It  is 
not  injurious  to  health  in  the  proportion  in  which  it 
exists  in  good  outside  air,  but  when  there  is  an  exces- 
sive amount  present,  due  to  some  form  of  contamina- 
tion, particularly  within  doors,  unpleasant  or  serious 
results  may  follow. 

The  moisture  which  is  more  or  less  constantly  pres- 
ent in  the  air  is  due  to  the  invisible  vapor  which  rises 
from  the  great  bodies  of  water  upon  the  earth's  sur- 
face and  which  returns  in  the  form  of  mist,  rain  and 
snow. 

Through  the  respiratory  tract  the  air  reaches  the 
lungs,  where  a  vitally  important  interchange  takes 
place.  Here  about  one-fourth  of  the  oxygen  contained 
in  the  air  entering  the  lungs  is  extracted  for  the  pur- 
pose of  enriching  the  blood,  to  renew  the  worn  out 
tissue  of  the  body  and  to  produce  heat.  In  exchange, 
carbon  dioxid  and  other  products  representing  waste 
matter  are  thrown  off  with  the  expired  air.  The  inter- 
change referred  to  takes  place  in  the  minute  air  cells 
which  have  been  described  in  the  preceding  chapter. 

In  connection  with  this  part  of  the  subject  it  is  very 
interesting  to   note   that  while   animals   absorb   oxy- 


64  GOOD  HEALTH 

gen  and  give  off  carbon  dioxid  as  a  waste  product, 
plants  depend  upon  carbon  dioxid  for  their  growth, 
and  liberate  oxygen.  It  is  largely  by  this  means  that 
the  proper  proportions  of  these  gases  in  the  air  are 
maintained. 

Impure  air  is  found  within  and  without  the  house. 
Outside  the  usual  sources  of  contamination  are  the  va- 
rious industrial  occupations — particularly  where  coal  is 
used  in  large  quantities,  the  combustion  of  which  gen- 
erates gases  injurious  to  health — too  closely  con- 
structed buildings,  narrow  and  filthy  streets  and  vari- 
ous forms  of  decomposing  matter. 

Nature  goes  far  to  neutralize  these  conditions  by  oxi- 
dation, by  winds  which  rapidly  displace  or  change  the 
air  and  freshen  it  and  by  rains  which  wash  or  carry 
down  all  sorts  of  contamination.  We  recognize  the 
improved  condition  of  the  air  after  a  storm.  Sunlight 
and  vegetation  are  also  important  factors  in  securing 
this  result. 

The  law  of  diffusion  of  gases  by  which  the  latter  mix 
with  or  work  through  each  other  is  an  exceedingly  im- 
portant factor  in  our  protection,  for  if  it  were  not  so, 
the  heavier  or  poisonous  gases  would  lie  close  to  the 
surface  of  the  earth,  and  our  life  would  be  very  brief. 

Within  a  building  the  sources  of  impurities  are  the 
exhalations  from  the  lungs,  mouth  and  skin  of  those 
present,  dust,  filth,  improper  ventilation,  bad  plumb- 
ing and  other  insanitary  conditions.  In  factories  and 
mines  there  are,  in  addition  to  these  impurities,  prod- 
ucts arising  from  particles  of  coal,  stone,  metal,  and 
poisonous  gases,  which  are  largely  responsible  for  the 


AIR  65 

diseases  commonly  found  among  the  workers  in  these 
places.  Air  is  carried  into  the  soil  and  when  mixed 
there  with  decomposed  organic  matter,  becomes  un- 
healthful  and  offensive.  Poisonous  and  inflammable 
gases  are  also  generated  beneath  the  surface  and  may 
be  found  at  a  considerable  depth.  When  excavations 
are  made,  or  during  mining  operations,  they  are  fre- 
quently released  and  are  not  only  detrimental  to  health, 
but  when  exposed  to  a  flame  or  the  oxygen  of  the  air 
may  cause  explosions.  Carburetted  hydrogen  or  ''fire- 
damp" is  an  illustration. 

Contamination  from  underground  sources  is  not  in- 
frequently the  cause  of  unhealthful  and  offensive  cel- 
lars, for  their  walls,  particularly  those  in  the  country, 
are  often  improperly  constructed  and  may  permit  un- 
derground gases  to  pass  through.  These  not  only  cause 
unpleasant  odors,  but  are  likely  to  contaminate  milk 
and  other  foodstuffs  which  may  be  present.  These 
gases  may  also  permeate  the  house. 

It  is  not  difficult  to  understand  why  those  who  work 
in  mines  or  places  where  the  air  is  contaminated  are 
frequent  victims  of  tuberculosis.  In  marked  contrast 
to  this  is  the  fact  that  those  who  are  most  free  from 
this  disease  are  farmers  and  fishermen  whose  occupa- 
tions keep  them  constantly  in  the  open  air. 

There  is  a  popular  belief  that  impure  air  may  be  the 
origin  of  infectious  diseases.  This  i^  not  true.  The 
danger  of  impure  air  lies  in  the  fact  that  it  lowers  the 
resisting  power  of  the  body  and  renders  it  more  sus- 
ceptible to  disease.  However,  this  only  occurs  where 
there  is  a  long  continued  exposure  to  polluted  air. 


66  GOOD  HEALTH 

Modern  sanitation  has  brought  about  a  more  serious 
realization  of  the  necessity  of  pure  air  both  to  the  sick 
and  the  well.  Physicians  have  studied  its  importance 
in  disease,  and  the  windows  of  sickrooms  are  no  longer 
kept  closed.  Certain  affections,  especially  tuberculosis, 
are  often  treated  in  the  open  air  with  most  satisfactory 
results,  and  medication  in  these  instances  has  to  a  great 
extent  been  discarded.  Sleeping  in  the  open  air  is  now 
a  common  practice  and  those  who  adopt  it  under  proper 
and  reasonable  conditions  discover  its  stimulating  and 
invigorating  effect.  Fresh  air  is  therefore  a  tonic  both 
in  health  and  sickness,  and  a  powerful  factor  in  com- 
bating disease. 

While  we  cannot  expect  to  find  absolutely  pure  air, 
for  the  air  we  breathe  contains  some  form  of  contam- 
ination, we  should  seek  for  good  fresh  or  moving  air, 
and  also  remember  that  it  is  the  maximum  and  not  the 
minimum  that  is  desired,  and  that  this  can  only  be 
found  out  of  doors.  The  belief  that  night  air  is 
detrimental  to  health  has  little  or  no  foundation. 

Ozone  is  a  modified  form  of  oxygen.  Its  existence 
in  the  lower  stratum  of  atmosphere,  except  under  spe- 
cial or  local  conditions,  has  not  been  definitely  proved. 
It  is  generated  during  thunderstorms  as  the  re- 
sult of  the  action  of  electricity  in  the  air,  and  it  is  often 
present  in  the  immediate  vicinity  of  an  electric  appa- 
ratus. At  these  times  it  may  be  recognized  by  its 
peculiar  odor,  which  somewhat  resembles  that  of  rub- 
ber. The  popular  notion  that  ozone  is  a  great  purifier 
has  been  responsible  for  many  theories  concerning  its 
healing  properties  in  connection  with  certain  diseases. 


AIR  67 

The  fact  that  comparatively  little  investigation  has 
been  made  in  regard  to  the  use  of  this  gas  for  practical 
purposes  furnishes  meager  information  as  to  its  pos- 
sibilities. Ozone  is  artificially  produced  by  electricity 
for  commercial  and  disinfecting  purposes.  It  is  a 
much  more  powerful  oxidizer  than  oxygen.  It 
bleaches,  and  is  destructive  to  bacteria. 

The  term  humidity  relates  to  the  moisture  contained 
in  the  air.  Sometimes  the  amount  is  very  great  during 
the  summer  and  goes  far  to  increase  the  uncomfort- 
able and  depressing  effect  of  the  hot  weather.  The 
regulation  and  cooling  of  the  body  temperature  de- 
pends largely  upon  the  proper  evaporation  of  the  wa- 
ter or  perspiration  discharged  upon  the  surface  of 
the  skin.  This  takes  place  much  more  rapidly  when 
the  air  is  dry  than  when  the  air  is  very  humid.  There- 
fore, if  the  atmosphere  is  well  saturated  with  water, 
less  heat  is  given  off  from  the  body,  and  the  physical 
effect  is  far  more  uncomfortable  and  oppressive.  It 
is  for  this  reason  that  high  localities  are  sought  for 
during  the  hot  season,  for  in  these  places  the  humidity 
is  usually  lower  and  the  air  is  correspondingly  dry  and 
bracing. 

Agitation  of  the  air  cools  the  body  by  causing  more 
rapid  evaporation  from  the  skin.  Therefore,  electric 
fans  used  during  the  warm  weather  have  a  very  grate- 
ful and  beneficial  effect,  provided  they  are  properly 
situated  in  the  apartment  and  not  too  close  to  its  oc- 
cupants. Otherwise,  they  may  have  the  effect  of 
drafts. 

A  very  important  and  interesting' part  of  the  sub- 


68  GOOD  HEALTH 

ject  of  atmosphere  relates  to  its  weight.  The  weight 
of  the  atmosphere  is  equivalent  to  about  fifteen  pounds' 
pressure  upon  every  square  inch  of  surface  at  the  level 
of  the  sea.  This  pressure  has  an  important  effect 
as  far  as  the  human  body  is  concerned,  for  it  main- 
tains the  equilibrium  of  the  heart's  action  and  the  cir- 
culation of  the  blood.  When  a  high  altitude  is  reached 
this  control  is  somewhat  lessened  as  the  weight  of  the 
air  is  diminished  and  the  heart  is  apt  to  become  dis- 
turbed and  very  small  blood-vessels,  particularly  those 
in  the  mucous  membrane  of  the  air  passages,  frequent- 
ly burst.  Nose  bleed  often  takes  place  under  these 
conditions.  These  occurrences  are  familiar  to  travelers 
who  ascend  lofty  mountains,  and  are  usually  unattend- 
ed with  danger,  unless  some  serious  organic  disease  of 
the  heart  or  blood-vessels  exists.  It  should  be  noted 
that  this  is  not  due  to  a  change  in  the  proportion  of  the 
gases  composing  the  air,  but  to  the  lessened  density  of 
the  atmosphere. 

The  pressure  of  the  air  affects  not  only  the  earth's 
surface,  but  also  every  object  upon  the  earth.  There- 
fore a  man  of  ordinary  size  probably  sustains  a  weight 
of  fifteen  or  sixteen  tons.  The  question  very  naturally 
arises :  Why  are  we  not  crushed  by  this  enormous 
pressure?  It  is  because  it  is  equally  distributed  and 
because  there  is  air  in  the  tissues  and  cavities  of  the 
body  which  presses  outward.  These  conditions  bring 
about  an  adjustment,  prevent  interference  with  the 
various  functions  and  render  us  unconscious  of  any 
pressure ;  yet  when  the  air  is  in  rapid  motion,  as  dur- 
ing windstorms,  we  can  appreciate  its  force  and  power. 


CHAPTER  IV 

WATER 

Chemically  pure  water  consists  of  two  volumes  of 
hydrogen  and  one  of  oxygen.  We  do  not  drink  pure 
water,  for  the  natural  supply  always  contains  vari- 
ous salts  as  well  as  some  form  of  contamination.  Some 
of  these  salts  are  necessary  for  our  well-being,  and  the 
contamination  which  occurs  in  good  healthful  water, 
which  may  be  termed  practically  pure,  is  so  slight  that 
it  may  be  regarded  as  a  negligible  factor.  The  chief 
danger  from  potable  water  lies  in  the  fact  that  it  may 
contain  infectious  germs. 

Water,  next  to  air,  is  most  necessary  to  our  ex- 
istence; without  it  we  could  live  only  a  few  days.  It 
plays  an  exceedingly  important  part  in  maintaining  the 
functions  of  the  organs  and  tissues,  and  forms  at  least 
four-fifths  of  all  the  food  we  take.  It  is  constantly 
needed  to  make  up  for  the  loss  of  moisture  from  the 
skin  and  lungs,  and  also  aids  in  preserving  the  shape 
and  symmetry  of  the  body  which  is  composed  of  sev- 
enty-five per  cent  of  water. 

Water  supplies  life  to  plants  and  to  all  living  things 
beneath  its  surface  through  the  oxygen  it  contains. 
Fish  removed  from  it  quickly  die  of  suffocation.  Their 
respiratory  apparatus  cannot  take  oxygen  from  the  air, 

69 


70  GOOD  HEALTH 

although  they  abstract  it  from  the  water,  which  we 
are  unable  to  do.  A  person  who  is  submerged  for 
more  than  four  or  five  minutes  is  not  usually  resusci- 
tated. 

The  ocean,  which  covers  more  than  three-fourths 
of  the  surface  of  the  globe,  is  the  natural  source  of 
our  water  supply.  From  it  arises,  through  the  action 
of  the  sun's  rays,  a  continuous  invisible  stream  of  va- 
por to  the  atmosphere.  This  is  afterward  condensed 
and  precipitated  in  the  form  of  mist,  rain  and  snow. 
At  least  three-fourths  of  this  returns  directly  to  the 
ocean,  while  the  part  falling  on  the  land  forms  rivers, 
lakes  or  pools  or,  penetrating  into  the  earth,  becomes 
the  great  underground  system  upon  which  we  depend 
largely  for  drinking  purposes. 

It  is  important  to  know  something  of  the  course 
taken  by  the  water  entering  the  ground  and  the  vari- 
ous combinations  it  forms  during  its  descent.  A  sec- 
tion of  the  earth  will  show  the  soil  arranged  in  various 
layers  or  strata.  The  significance  of  this  as  indicating 
the  formation  and  age  of  the  earth  is  well  known  to 
the  geologists.  It  is  also  of  great  interest  in  connection 
with  the  underground  water  system,  for  it  explains 
the  manner  in  which  it  is  collected  and  distributed. 

The  layers  referred  to  are  variously  composed  of 
sand,  gravel,  chalk,  clay  and  other  like  substances. 
Some  of  these^  clay  for  instance,  are  practically  im- 
permeable, i.  e.,  water  cannot  pass  through  them.  On 
the  other  hand,  sand  is  easily  penetrated.  Therefore, 
water  in  its  descent  passes  without  difiiculty  through 
the  sand  and  upon  reaching  a  layer  of  clay  or  some 


WATER  71 

other  impermeable  stratum  is  directed  along  until  it 
finds  an  exit  somewhere.  This  may  occur  in  the  form 
of  a  spring  or  as  a  supply  to  some  body  of  water,  or  it 
may  remain  below  until  an  outlet  is  made  for  it  in 
the  form  of  a  well. 

The  strata  found  at  various  levels  are  not  uniformly 
arranged  and  are  frequently  curved,  sometimes  form- 
ing large  underground  basins.  As  a  result,  water  upon 
entering  the  earth  may  reach  an  impermeable  stratum 
at  different  depths  and  supply  superficial  or  deep  wells. 

Innumerable  forms  of  impurities  are  carried  into 
the  ground  by  the  surface  water.  Many  of  these  are 
filtered  out  by  the  soil;  some  are  destroyed  by  oxida- 
tion, for  air  passes  into  the  ground;  and  some  are  de- 
stroyed by  certain  forms  of  bacteria  or  germs  which 
live  upon  organic  matter.  For  this  reason  water  be- 
comes purer  as  it  goes  farther  into  the  earth,  and  we 
may  expect  to  find  a  better  and  safer  water  supply 
in  a  deep  well  than  in  a  superficial  one. 

Certain  gases  confined  in  the  earth  sometimes  force 
underground  waters  to  the  surface,  although  this  is 
usually  brought  about  by  the  pressure  of  the  water 
from  behind  in  its  efforts  to  reach  its  own  level.  A 
supply  frequently  has  its  origin  in  mountainous  regions, 
or  where  there  is  considerable  elevation,  and  may 
follow  along  impermeable  strata,  sometimes  to  a  con- 
siderable depth,  and  appear  at  the  surface  by  natural 
or  artificial  agencies  many  miles  away. 

Not  infrequently  heated  water,  which  probably  has 
its  origin  in  the  earth,  reaches  the  surface  and  forms 
what  are  known  as  "hot  springs."    The  various  condi- 


^2  GOOD  HEALTH 

tions  above  referred  to  have  led  to  the  establishment 
of  many  celebrated  resorts,  water  cures  and  springs 
throughout  the  world. 

Water  is  one  of  the  most  important  of  solvents,  and 
during  its  transit  through  the  earth,  various  chemical 
changes  take  place.  The  soil  is  rich  in  carbonic  acid, 
and  the  underground  water,  holding  this  gas  in  solu- 
tion, dissolves  out  various  mineral  substances  con- 
tained in  the  strata  with  which  it  comes  in  contact.  In 
some  instances,  the  presence  of  these  salts  is  so  pro- 
nounced that  the  water  is  unfit  for  general  use,  al- 
though in  this  condition  it  is  sometimes  employed  for 
medicinal  purposes.  Water  most  frequently  combines 
with  lime  and  magnesia,  particularly  the  former.  When 
a  comparatively  large  amount  of  it  is  present,  the 
water  becomes  ''hard,"  i.  e.,  the  lime  or  magnesia  com- 
bines with  the  fatty  acids  of  soap  and  prevents  the 
prompt  formation  of  lather.  For  this  reason,  the  hard 
water  is  neither  satisfactory  nor  economical  for  bath- 
ing or  domestic  purposes.  While  it  is  believed  by  some 
that  the  long  continued  use  of  hard  water  for  drink- 
ing purposes  may  cause  certain  affections,  it  is  prob- 
able that  there  is  little  danger  from  this  source  pro- 
vided the  water  is  not  too  hard,  although  it  may  not 
be  as  palatable  as  some  other  kind.  Water  which 
contains  little  or  no  Hme  is  called  ''soft"  and  is  better 
and  pleasanter  for  general  use. 

If  it  were  possible  to  collect  rain  water  above  the 
point  of  contamination,  it  would  be  the  purest  and 
softest  supply  we  could  obtain ;  but  during  its  descent, 
some    form   of   pollution   always   takes   place,    for   it 


WATER  73 

washes  out  the  air.  In  the  country  the  contamination 
is  comparatively  sHght,  but  in  cities  and  manufacturing 
towns,  where  the  air  is  constantly  charged  with  poison- 
ous gases,  products  of  offensive  trades  and  the  usual 
pollution  of  these  places,  the  rain  water,  unless  puri- 
fied, is  usually  unfit  for  drinking  purposes. 

In  regions  where  there  is  no  general  water  supply 
to  draw  from,  such  as  springs,  rivers,  lakes,  etc.,  and 
where  little  can  be  secured  from  underground  sources 
owing  to  the  peculiar  formation  of  the  soil,  rain  water 
is  carefully  and  eagerly  collected.  In  emergencies  it 
is  often  caught  upon  canvas  or  rubber  cloths,  and  for 
general  use  large  ground  areas  with  cemented  floors 
and  underground  storage  cisterns  are  sometimes  em- 
ployed. Although  the  more  common  method  is  to  col- 
lect it  in  receptacles  as  it  runs  from  the  roofs  of  build- 
ings. As  a  rule,  little  attention  is  given  to  the  clean- 
liness of  these  surfaces,  yet  it  is  of  great  importance  if 
the  water  is  used  for  drinking  purposes.  A  meas- 
ure of  protection  against  contamination  may  be  se- 
cured by  having  the  waste  pipe  from  the  roof  so 
constructed  that  it  can  be  quickly  disconnected  from 
the  storage  tank  or  barrel  at  the  beginning  of  the 
rain  and  allowed  to  discharge  over  the  ground  for  a 
few  minutes  in  order  that  the  roof  may  be  cleaned, 
and  then  reconnected  with  the  receptacle.  A  high- 
pitched  slate  roof  offers  the  best  advantages  so  far  as 
this  form  of  rain  water  collection  is  concerned;  it  is 
much  easier  to  clean. 

Careful  attention  should  be  given  to  the  construc- 
tion of  storage  tanks  or  cisterns.    They  should  not  be 


74  GOOD  HEALTH 

made  of  lead,  for  rain  or  other  soft  water  will  dis- 
solve the  metal  and  render  the  water  unfit  for  drinking 
purposes.  For  the  same  reason  lead  pipes  should  not 
be  used  for  the  transmission  of  drinking  water.  Iron 
tanks  may  discolor  the  water  and  also  make  it  un- 
pleasant for  drinking.  These  tanks  should  be  con- 
structed preferably  of  Portland  cement,  slate  or  enam- 
eled ware,  which  gives  off  no  objectionable  product 
and  can  be  cleaned  easily  and  promptly.  Galvanized 
iron  may  be  used,  although  it  is  inferior  to  the  ma- 
terials just  referred  to.  Wood  is  commonly  used  for 
the  construction  of  storage  tanks,  particularly  on  the 
tops  of  buildings  where  it  is  necessary  that  the  weight 
of  these  receptacles  should  be  reduced  to  the  mini- 
mum. The  objection  to  it  is  that  it  rots  and  leaks,  ab- 
sorbs unpleasant  odors  and  cannot  be  properly  cleaned. 
A  storage  tank  should  have  an  outlet  at  the  bot- 
tom which  will  permit  the  free  escape  of  its  contents 
in  order  that  it  may  be  properly  cleaned.  For 
cleaning  there  is  no  better  agent  than  a  solution  of 
soda  and  hot  water  applied  with  a  long-handled  brush ; 
the  tank  afterwards  should  be  carefully  rinsed  out. 
The  brush  should  be  boiled  in  water  for  at  least  five 
minutes  immediately  preceding  its  use,  to  destroy  any 
bacteria  which  may  be  present.  If  the  tank  is  of  a  very 
large  size,  it  is  a  common  practice  for  the  cleaner  to 
go  inside  the  receptacle.  Infective  material  is  in  this 
way  undoubtedly  transmitted  by  the  feet.  If  this 
method  is  employed  the  cleaner  should  wear  rubber 
boots,  which  have  just  previously  been  heated  in 
boiling  water. 


WATER  75 

Underground  tanks  for  the  storage  of  water  are  to 
be  condemned  under  all  circumstances.  If  improperly 
constructed,  they  are  not  only  liable  to  admit  poison- 
ous gases  from  the  surrounding  soil,  but  are  subject 
to  all  sorts  of  surface  contamination.  Besides,  when 
not  efficiently  covered,  small  animals  not  infrequently 
fall  into  them  and  are  drowned.  Like  all  tanks,  they 
are  favorite  breeding  places  for  mosquitoes.  Further- 
more, this  class  of  tanks  cannot  be  properly  cleaned. 

The  demand  for  modern  methods  of  waste  disposal 
in  country  homes,  which  is  referred  to  later  on,  calls 
for  the  construction  of  storage  tanks  on  the  roof  or 
in  the  top  floor  of  the  house.  These  should  have  a 
capacity  of  about  five  thousand  gallons  for  drinking, 
flushing  and  other  purposes.  These  tanks  should  be 
closed  with  a  tight-fitting  cover  and  ventilated  by  a 
pipe  from  the  cover  to  the  outside  of  the  building, 
which  should  have  a  bend  in  order  that  foreign  bodies 
cannot  reach  the  contents  of  the  tank. 

Rain  water  barrels  found  about  country  homes  are 
usually  in  an  unsanitary  condition  and  imperfectly 
covered.  They  also  serve  as  breeding  places  for  mos- 
quitoes. This  is  so  notorious  that  the  common  torm 
of  this  insect  is  known  as  the  "rain-barrel"  mosquito. 

Spring  water  is  usually  cold,  sparkling  and  re- 
freshing, and  therefore  very  palatable.  Spring  water 
may  be  quite  free  from  impurities  in  the  country,  but 
in  towns  and  cities  there  is  always  danger  of  contami- 
nation, for  the  water  may  come  through  superficial 
strata  and  receive  impurities  from  the  surface.  When 
spring  water  is  used,  it  should  be  protected  against 


'jd  GOOD  HEALTH 

contamination  at  its  exit  by  a  stone  or  cement  walls 
and  floor.  In  addition,  a  pipe  may  be  introduced  into 
the  opening,  not  only  for  protection  but  to  conduct  the 
water  more  effectively  to  its  exit. 

Lake  water,  particularly  from  the  mountain  slopes, 
furnishes  a  very  satisfactory  drinking  supply,  for  it  is 
relatively  pure.  The  water  is  still  and  the  organic 
matter  and  other  forms  of  impurities  which  it  contains 
easily  settle  to  the  bottom;  moreover,  oxidation  goes 
far  to  destroy  impurities  on  the  surface.  There  is 
considerable  truth  in  the  saying  that  lakes  clean  them- 
selves. When  this  supply  is  used  for  drinking  pur- 
poses, there  should  be  the  most  rigid  and  constant  con- 
trol to  prevent  the  discharge  of  sewage  or  other 
forms  of  filth  into  the  water,  and  the  intake  should  be 
some  distance  from  the  shore  to  prevent  still  further 
the  danger  of  contamination.  The  safety  of  this 
form  of  water  supply  must  always  be  seriously  ques- 
tioned if  the  border  of  the  lake  is  inhabited. 

River  water,  which  is  often  used  as  a  general  water 
supply,  is  very  apt  to  be  unfit  to  drink  except  at  its 
head  in  rriountains  and  tributaries  which  are  not  con- 
taminated, or  before  it  receives  the  waste  and  sew- 
age of  towns.  The  ease  and  economy  with  which 
municipalities  can  draw  water  from  these  sources  have 
led  to  many  serious  results  as  far  as  general  infection 
is  concerned. 

River  water  used  by  large  communities  for  drinking 
purposes  is  generally  filtered  or  otherwise  treated  for 
the  purpose  of  purification.  The  former  method 
usually  consists,  in  brief,  of  passing  the  water  over 


WATER  y-j 

filter  beds  composed  of  gravel  on  top  of  which  is  a 
layer  of  fine  sand  three  or  four  feet  in  depth.  Impuri- 
ties are  removed  as  the  water  passes  down  through 
the  permeable  layers  to  its  destination  or  receivers.  If 
this  method  is  properly  carried  out  the  intake  is 
largely  freed  from  bacteria  and  other  forms  of  con- 
tamination. The  important  protective  factor  in  this 
process  is  the  sand,  although  a  scum  or  layer,  ex- 
tracted from  the  water,  which  forms  on  the  top  of 
the  sand,  also  acts  as  a  filter  and  is  of  value  as  a  puri- 
fying agent. 

This  means  of  purification,  however,  cannot  be  de- 
pended upon  and  river  water  for  drinking  purposes  in 
inhabited  regions  is  always  a  menace  to  the  public 
health.  The  ancient  Romans  were  aware  of  this,  for 
although  the  River  Tiber  runs  through  the  City  of 
Rome,  water  was  brought  from  distant  sources  by 
aqueducts  so  splendidly  constructed  that  some  por- 
tions are  still  in  use. 

Well  water  is  a  common  source  of  supply  in  this 
country,  and,  like  spring  water,  is  cool  and  pleasant  to 
drink.  Unfortunately,  wells  are  frequently  contami- 
nated, and  in  this  way  may  convey  infectious  ma- 
terial; for  instance,  typhoid  fever  is  sometimes  trans- 
mitted by  this  means  and  partly  explains  why  this  dis- 
ease often  occurs  in  rural  districts. 

Deep  wells  are  less  dangerous  as  far  as  infection 
is  concerned  than  superficial  ones,  for  the  water  from 
the  former  is  usually  drawn  from  a  deeper  stratum; 
yet  defective  construction  will  allow  surface  impuri- 
ties to  reach  the  interior  of  even  deep  wells  throug^h 


78  GOOD  HEALTH 

their  walls.  Artesian  wells  constitute  an  exception 
to  this,  for  they  are  sometimes  bored  to  a  depth  of 
many  hundred  feet  to  reach  below  or  between  imper- 
meable strata  where  water  is  held  under  pressure. 
This  escapes  to  the  surface  through  a  continuous  pipe 
or  tube  which  if  properly  constructed  admits  of  but 
little  danger  from  contamination,  particularly  if  the 
exit  is  carefully  protected.  For  this  reason,  arte- 
sian well  water  may  often  be  used  with  safety  in  built- 
up  communities,  although  in  all  instances  they  should 
be  under  the  observation  of  health  authorities. 

There  is  need  of  protection  about  the  opening  of 
an  ordinary  well,  as  the  space  immediately  surrounding 
it  is  often  a  fruitful  source  of  contamination,  and  for 
a  distance  of  a  few  feet  at  least  this  should  be  graded 
and  cemented  from  the  edge  of  the  wall  outward  and 
downward.  The  open  or  ''old  oaken  bucket"  system 
is  anything  but  sanitary.  In  its  place  a  modern  pump- 
ing apparatus  should  be  used  so  that  the  opening  of 
the  well  can  be  closed  and  protected  against  pollution 
and  the  entrance  of  small  animals. 

The  ordinary  dug  well  is  cylindrical  and  is  usually 
lined  with  brick  or  stone  and  cement.  The  safety  of 
this  means  of  water  supply  is  greatly  enhanced  if  the 
outside  of  the  wall  or  structure  of  the  well  is  tarred. 

As  a  well  may  receive  infectious  matter  from  a 
nearby  broken  drain  or  privy  vault,  cesspool  or  the 
like  through  the  soil,  it  is  necessary  in  addition  to  the 
proper  construction  that  it  be  placed  at  the  highest 
practicable  point  and  as  far  as  possible  from  all  chance 
of  pollution.     A  safe  distance  cannot  be  arbitrarily 


WATER  79 

stated,  for  the  danger  of  infection  depends  largely 
upon  the  arrangement  of  the  underground  strata. 
However,  a  well  may  be  placed  fairly  out  of  harm's 
w^ay  by  a  careful  study  of  the  conditions  already  re- 
ferred to.  The  danger  of  contaminating  a  well  from 
surface  drainage  is  probably  much  exaggerated, 
yet  it  may  occur  where  fissures  or  cracks  exist  in 
the  grounds. 

It  is  a  practice  among  those  who  frequently  make 
short  excursions  into  the  country  to  drink  clear  cold 
well  water  whenever  it  can  be  found.  This  is  un- 
safe, particularly  where  the  wells  are  not  in  constant 
use.  Water  from  this  source  should  not  be  used  for 
drinking  purposes  unless  after  careful  inquiry  and  ob- 
servation there  is  reasonable  evidence  that  it  is  not 
contaminated.  Some  form  of  infection  might  be  the 
result  of  omitting  this  precaution. 

The  ova,  or  eggs,  of  various  parasites,  such  as  the 
tapeworm,  hookworm,  and  roundworm,  which  are  ex- 
pelled from  the  intestinal  tract,  may  reach  a  water 
supply.  Not  infrequently  small  streams  or  creeks, 
which  furnish  water  cool  and  pleasant  to  drink,  are 
contaminated  through  sewage  which  empties  into 
them.  Therefore,  water  from  these  streams  should 
not  be  used  for  drinking  purposes,  nor  should  the  wa- 
tercress or  other  vegetation  which  grows  in  them  be 
eaten  unless  there  is  substantial  proof  that  there  is  no 
pollution  present. 

The  need  of  water  in  the  preservation  of  health  is 
far  from  being  appreciated  and  as  a  rule  we  do  not 
drink  enough  of  it.    A  lack  of  water  often  leads  to 


8o  GOOD  HEALTH 

indigestion,  torpidity,  constipation,  headache,  dryness 
of  the  skin,  etc. 

It  is  estimated  that  the  adult  human  being  requires 
about  two  quarts  of  water  within  the  twenty- four 
hours.  One-third  of  this  is  usually  taken  in  with  the 
food.  "In  addition,  four  or  five  glasses  during  the  day 
under  ordinary  conditions  would  be  a  fair  estimate 
of  the  amount  required  by  the  system.  It  is  subject 
to  great  variations,  depending  largely  upon  exercise 
and  climatic  conditions,  for  during  the  warm  weather 
the  activity  of  the  skin  rapidly  abstracts  large  quanti- 
ties of  water  from  the  body  which  should  be  promptly 
replaced. 

Contrary  to  the  general  belief,  there  is  no  objection 
to  drinking  a  reasonable  amount  of  water  with  meals, 
although  it  should  not  be  confined  to  this  time  but 
distributed  more  evenly  throughout  the  day.  It  is  not 
harmful  to  drink  moderately  of  iced  water,  particu- 
larly during  the  warm  weather,  for  it  aids  in  cooling 
the  body.  It  may  be  added  that  horses  under  ordinary 
conditions  drink  about  eight  gallons  of  water  daily 
and  cattle  somewhat  less. 

The  importance  of  water  in  maintaining  health  re- 
quires that  the  supply  shall  be  as  pure  as  possible. 
We  shall  learn  as  we  go  further  into  the  subject  that 
nature  does  not  demand,  that  what  we  eat  and  drink 
and  the  air  we  breathe  shall  be  absolutely  pure,  for  it 
is  tolerant  of  a  certain  amount  of  adulteration.  Some 
form  of  impurity  almost  always  exists,  particularly  in 
municipal  water  supplies.  The  danger  is  not  so  much 
from    ordinary    contamination   but   rather    from   the 


WATER  8t 

presence  of  infectious  germs  which  are  not  apparent 
from  the  appearance,  for  the  clearest  and  apparently 
purest  specimens  of  the  water  may  contain  germs  of 
disease. 

It  is  reasonable  to  assume  that  if  there  is  no  marked 
prevalence  of  water-borne  diseases,  such  as  typhoid 
fever  and  dysentery,  the  general  supply  of  a  town  or 
city  may  be  drunk  with  safety.  Reliable  information 
regarding  this  matter  may  usually  be  obtained  from 
the  local  health  officer. 

It  is  a  common  practice,  even  in  cities  and  towns 
where  the  safety  of  the  general  water  supply  has  been 
reasonably  established,  to  drink  bottled  waters  for  the 
alleged  purpose  of  escaping  infection.  This  practice 
not  only  inspires  fear  but  is  usually  without  justifica- 
tion and  should  not  be  resorted  to  unless  in  some 
special  instance  it  is  recommended  by  the  municipal 
health  authorities.  Furthermore,  there  is  doubt  as 
to  the  purity  of  some  of  the  bottled  waters  offered  for 
sale. 

There  are  many  methods  proposed  and  innumerable 
types  of  water  filters  offered  for  sale  for  the  clarifica- 
tion and  purification  of  drinking  water,  chiefly  for 
domestic  purposes.  A  large  percentage  of  these  filters 
find  their  way  to  country  homes  in  response  to  a 
demand  for  some  appliance  or  means  which  will  afford 
protection  against  contaminated  water. 

While  not  attempting  to  discuss  the  relative  merits 
of  the  various  filters,  it  may  be  said  that  some  render 
very  efficient  aid  in  the  purification  of  water,  but 
a  large  proportion  of  them  are  practically  worthless. 


82  GOOD  HEALTH 

Furthermore,  the  public  does  not  as  a  rule  seek  proper 
advice  in  the  selection  of  these  apparatus,  but  are  quite 
willing  to  accept  the  very  plausible  recommendation 
of  their  makers. 

The  home  practice  of  clarifying  water  by  the  use 
of  alum,  tea  leaves,  etc.,  is  not  entitled  to  considera- 
tion, for  it  is  worse  than  useless.  It  suggests  a  pro- 
tection which  is  only  imaginary,  for  these  methods 
do  not  destroy  infectious  organisms  which  may  exist 
in  the  water. 

In  small  communities  and  in  the  country  where  no 
properly  organized  health  protection  exists  one  should 
be  particularly  alert  in  guarding  against  impure  drink- 
ing water.  This  may  be  done  by  carefully  bearing  in 
mind  the  way  in  which  water  supplies  are  collected 
and  the  ordinary  means  of  contamination.  But  fur- 
ther and  still  more  important  is  the  need  of  a  periodical 
bacteriological  examination  of  all  drinking  water  which 
is  not  a  part  of  a  general  or  common  supply  and  un- 
der the  careful  observation  of  municipal  health  au- 
thorities. Moreover,  such  an  examination  should  be 
made  whenever  there  is  suspicion  of  contamination. 
There  is  no  filter  or  domestic  remedy  which  may  be 
safely  accepted  as  a  substitute  for  this.  This  is  in 
line  with  modern  sanitation  and  not  an  impracticable 
procedure,  for  it  is  quite  probable  that  every  State 
in  the  Union  as  well  as  every  city  is  equipped  with 
laboratory  facilities  where  water  and  other  suspected 
fluids  and  solids  are  examined  free  of  charge.  Be- 
sides, the  means  of  communication  throughout  the 
country  are  now  so  extended  and  rapid  that  even  in  a 


WATER  83 

remote  section  a  report  may  be  obtained  within  a  com- 
paratively short  time.  In  addition  there  are  many  pri- 
vate laboratories  located  throughout  the  country  where 
such  examinations  are  made  for  a  small  fee.  A  de- 
creased mortality  would  furnish  proof  as  to  the  value 
of  this  means  of  public  protection. 

There  are,  of  course,  many  instances  where  a  lab- 
oratory report  cannot  be  obtained  promptly  and  the 
exigencies  of  the  occasion  demand  that  some  immedi- 
ate action  be  taken  to  protect  the  community  against  a 
presumably  contaminated  water  supply.  Fortunately 
there  is  a  means  which  is  unfailing  in  its  action,  always 
available  and  practically  without  cost;  that  is,  the  ap- 
plication of  heat  by  boiling  the  water.  By  this  means 
all  disease-bearing  germs  which  affect  human  beings 
are  promptly  destroyed.  To  accomplish  this  water 
should  be  continuously  boiled  for  at  least  five  minutes ; 
simply  bringing  the  water  to  a  boiling  point  does  not 
always  answer  the  purpose. 

Boiling  renders  the  water  somewhat  flat  to  the  taste 
as  the  air  which  it  contains  is  expelled  by  the  heat. 
This  may  be  overcome  by  aeration,  or  by  agitating  the 
water  in  an  ordinary  churn  which  is  known  to  be  clean^ 
or  letting  it  escape  through  a  receptacle  containing 
numerous  little  holes  in  order  that  it  may  be  finely 
divided  and  better  combine  with  the  air  in  its  descent 
to  another  receiver.  It  is  far  safer,  while  the  emer- 
gency exists,  to  drink  the  water  as  it  is  boiled  rather 
than  employ  means  which  through  carelessness  may 
again  infect  it,  unless  some  person  in  the  house  is  aj>- 
pointed  personally  to  take  charge  of  the  work. 


l^  GOOD  HEALTH 

One  of  the  dangers  of  traveling  by  sea  in  the  past 
was  due:  to  the  contamination  of  drinking  water  on 
chipboard.  This  supply  was  carried  in  casks  or  tanks 
which  were  often  in  a  filthy  condition,  and  through 
•carelessness  infectious  germs  were  not  infrequently  in- 
troduced into  these  receptacles  and  diseases  transmitted 
to  those  on  shipboard.  Now  all  war  vessels  and  the 
.great  ocean  passenger  steamships  have  distilling  appa- 
ratus on  board  which  render  sea  water  fit  and  pure 
for  drinking  purposes  in  an  inexhaustible  amount. 
There  is  no  doubt  that  in  the  future  this  method  of 
'Obtaining  water  free  from  contamination  will  be  greatly 
•extended. 

In  connection  with  the  subject  of  water,  it  is  proper 
•that  some  reference  be  made  to  ice.  It  is  a  common 
belief  that  infectious  organisms  existing  in  water  are 
destroyed  when  freezing  takes  place.  This  does  not 
.always  occur,  for  some  special  organisms  survive  the 
reduction  of  temperature.  This  has  been  proved  in 
the  case  of  the  germs  of  typhoid  fever. 

Although  natural  ice  may  be  obtained  from  sources 
ivhere  there  is  no  serious  contamination,  it  is  well 
Icnown  that  it  frequently  comes  from  bodies  of  water 
which  receive  sewage  from  large  towns.  To  what 
^extent  ice  under  these  circumstances  becomes  involved, 
it  is,  of  course,  impossible  to  determine,  although  the 
danger  from  this  source  is  largely  overestimated. 

In  guarding  against  the  danger  from  impure  ice  it 
would  seem  practica}  and  logical  to  use  the  kind  of  ice 
which  so  far  as  we  can  ascertain  is  least  harmful.  Ar- 
tificial ice  is  more  apt  to  be  pure,  for  it  is  usually  made 


WATER  85 

from  distilled  water.  It  is  sometimes  stated  that  it  is 
rendered  unsafe  by  the  ammonia  used  in  its  manufac- 
ture. That  is  not  so,  for  the  ammonia  does  not  come 
in  direct  contact  with  the  water,  but  is  confined  in 
pipes,  and  used  simply  for  freezing  purposes. 

The  more  common  danger  from  ice  relates  to  the 
careless  manner  in  which  ice  is  stored  and  conveyed 
from  the  storehouse  to  the  table.  This  may  constitute 
a  very  fruitful  source  of  contamination.  Unfortu- 
nately, this  receives  but  little  attention  from  the  public. 


CHAPTER  V 

FOOD 

Food  has  been  likened  very  properly  to  the  fuel 
which  supplies  an  engine  with  motive  power.  Food 
generates  heat  and  energy  and  by  this  means  keeps 
the  body  in  a  state  of  activity.  But  food  in  addition  to 
this  is  required  to  replace  worn  out  tissues  and  furnish 
nourishment  for  increased  growth. 

Scientists  have  determined  the  composition  *of  the 
human  body  and  the  character  of  the  food  best  suited 
for  its  support,  and  were  it  possible  to  give  directly 
to  the  various  tissues  the  material  most  needed  for 
their  sustenance,  as  well  as  substances  best  suited  for 
the  generation  of  heat  and  energy,  the  problem  of  nu- 
trition would  be  easily  solved ;  but  the  food  we  eat  is 
subjected  to  the  processes  of  digestion  and  assimila- 
tion and  therefore  reaches  its  destination  in  a  changed 
and  roundabout  way.  Still,  the  knowledge  we  possess 
of  these  processes  enables  us  to  do  much  toward  se- 
curing the  desired  results. 

For  instance,  we  have  learned  that  bone  is  composed 
of  animal  and  earthly  matter  which  furnishes  elasticity 
and  strength.  Bone,  therefore,  must  be  supplied  with 
food  suitable  for  maintenance  of  both  of  these  ele- 
ments ;  if  not,  trouble  is  quite  sure  to  follow.    If  there 

86 


FOOD  87 

is  not  enough  earthy  matter  present  in  the  form  of 
lime,  the  bones  are  liable  to  become  bent  and  distorted, 
particularly  in  the  lower  extremities  which  support  the 
weight  of  the  body.  This  frequently  takes  place  in 
rickets,  a  disease  which  not  uncommonly  affects  chil- 
dren. On  the  other  hand,  the  muscular  system,  which 
renders  the  body  capable  of  the  freest  movement,  re- 
quires a  different  kind  of  food  to  maintain  its  integrity. 
Then,  again,  the  secretion-producing  organs  of  the 
body  which  have  most  important  functions  to  per- 
form, must  be  provided  with  plenty  of  water,  various 
salts  and  other  materials  from  which  to  manufacture 
their  special  product. 

NUTRITION 

At  the  risk  of  entering  a  more  technical  field,  some 
space  will  be  devoted  to  the  consideration  of  the  vari- 
ous groups  of  food,  the  terms  which  are  used  to  dis- 
tinguish them  from  each  other,  and  their  relative  value 
as  tissue  builders  and  generators  of  heat  and  energy. 

Food  is  classified  as  organic  and  inorganic. 

Organic  substances  consisting  of  animal  and  vege- 
table matter  are  subdivided  into  those  which  contain 
nitrogen  and  those  which  do  not. 

The  organic  nitrogenized  foods  are  known  as  pro- 
teins, a  word  which  means  ''the  most  necessary  food." 
This  class  of  food  is  truly  necessary,  for  the  nitrogen 
contained  in  it  is  required  in  the  construction  of  new 
and  the  repair  of  old  tissues  and  in  the  proper  nour- 
ishment of  the  body.  Without  it  we  could  live  but 
a  short  time.     Nitrogen  used  in   this  way  is  taken 


88  GOOD  HEALTH 

into  the  system  in  the  food  and  not  in  connection 
with  the  air  we  breathe.  The  function  of  nitrogen  in 
the  air,  as  we  have  already  learned,  is  chiefly  mechan- 
ical, for  it  dilutes  the  oxygen  which  otherwise  would 
be  too  stimulating  for  respiration. 

Some  of  the  more  common  and  well  known  forms  of 
proteins  are  meats,  the  albumen  or  white  of  egg,  the 
casein  of  milk  and  the  gluten  of  flour.  The  chief 
function  of  proteins  is  the  building  and  repair  of  tis- 
sues, muscle  for  instance.  They  are  also  used  to  a 
certain  extent  in  the  generation  of  heat. 

The  organic  non-nitrogenized  food,  as  the  name  im- 
plies, contains  no  nitrogen.  It  occurs  in  the  forms  of  su- 
gars (carbohydrates)  and  fats.  Starches,  which  through 
various  sources  form  an  exceedingly  important  part  of 
our  diet,  are  also  included  with  the  former,  for  during 
digestion  they  are  transformed  into  sugar,  the  form  in 
which  they  enter  the  system.  The  organic  non-nitro- 
genized substances  are  not  concerned  in  tissue  building, 
but  are  heat  and  energy  producers,  and  therefore  im- 
portant agents  of  nutrition. 

Fat  has  also  a  mechanical  function.  It  is  deposited 
immediately  under  the  skin  as  well  as  in  the  deeper 
■structures.  As  it  is  a  poor  conductor  of  heat  and  cold, 
it  aids  in  retaining  the  warmth  of  the  body  and  pro- 
tects against  the  cold  from  without.  Fat  is  also  found 
over  parts  exposed  to  pressure,  where  it  acts  as  a  pad 
or  protector  against  injury.  Furthermore,  it  goes  far 
towards  maintaining  the  symmetry  and  beauty  of  the 
body. 

Both  organic  nitrogenized  and  non-nitrogenized  sub- 


FOOD  89 

stances  in  supplying  nourishment  and  energy  lose  their 
identity,  i.  e.,  they  become  changed  in  character,  and 
are  not  recognized  in  the  waste  matter  expelled  from 
the  body  through  the  intestinal  tract,  kidneys,  lungs 
and  skin. 

Ino7'ganic  substances  consist  of  water  and  various 
salts,  for  example,  common  salt  (sodium  chlorid), 
lime,  soda  and  magnesia.  These  are  necessary  to 
maintain  life.  Everyone  who  has  lived  in  the  country 
is  familiar  with  the  importance  of  supplying  cattle  and 
other  livestock  with  sufficient  salt;  if  deprived  of  it, 
they  generally  decline  in  health  and  die. 

The  inorganics  are  especially  needed  in  connection 
with  the  various  secretions  which  have  been  referred 
to  in  a  previous  chapter.  Inorganic,  unlike  organic 
substances,  are  eliminated  from  the  body  in  the  same 
form  in  which  they  enter.  Water  and  salt,  for  in- 
stance, enter  the  body,  perform  their  functions  and  are 
discharged  as  water  and  salt. 

Many  of  the  former  theories  concerning  nutrition 
have  been  abandoned  as  the  result  of  recent  investiga- 
tion. For  instance,  it  has  been  quite  clearly  demon- 
strated that  proteins  do  not  directly  form  or  repair  old 
tissue,  but  that  all  food  entering  the  body  undergoes 
a  chemical  change,  known  as  digestion;  and  that  fol- 
lowing this  the  food  products  either  are  used  for  con- 
struction and  repair  of  the  various  tissues  of  the  body, 
or  are  burned  to  produce  heat  and  energy.  The  latter 
is  due  to  the  presence  of  oxygen  which  is  abstracted 
from  the  air  in  the  lungs  by  the  blood  as  it  passes 
through    these    organs.      The    sum    of    the    chemical 


90  GOOD  HEALTH 

changes  which  take  place  under  the  influence  of  living 
cells  is  known  as  metabolism. 

DIET 

Having  considered  in  a  general  way  the  material  re- 
quired for  the  nourishment  of  the  body,  we  are  better 
able  to  understand  the  value  of  the  various  articles 
of  food,  particularly  under  special  conditions.  It  has 
been  the  custom  of  athletes  while  in  training  to  eat 
sparingly  of  sugars  and  fats  which  increase  the  weight 
and  are  believed  to  add  little  to  the  muscular  power 
of  the  body,  but  to  depend  chiefly  upon  proteins,  such 
as  eggs,  meat  and  the  like,  from  which  to  secure  ad- 
ditional strength  and  proper  material  to  replace  worn 
out  muscular  tissue,  for  there  is  a  pressing  need  of 
this  during  long  continued  and  excessive  muscular 
exercise.  Proteins  may  be  depended  upon  to  do  this; 
however  it  is  now  thought  that  sugars  and  fats  are 
also  factors  in  maintaining  strength — for  a  while  at 
least.  In  confirmation  of  this  it  is  reported  that  dur- 
ing the  present  war,  German  soldiers  have  been  sub- 
jected to  prolonged  and  active  exercise  with  a  very 
limited  supply  of  protein  food. 

During  convalescence  from  fevers  or  where  emacia- 
tion exists,  as  in  tuberculosis  and  other  wasting  con- 
ditions, fats  and  sugars  are  particularly  indicated  to 
make  up  for  the  general  drain  on  the  system,  although 
proteins  are  also  required.  Aside  from  these  special 
or  temporary  conditions,  it  will  not  be  difficult  to 
understand  that  a  mixed  diet  which  contains  all  forms 
of  food  is  essential  to  continued  health  and  strength. 


FOOD  91 

During  the  past  half  century  much  has  been  done 
in  the  way  of  excluding  fish,  flesh  and  fowl  from  the 
diet,  and  also  confining  the  character  of  the  food 
within  even  narrower  limits — to  fruits  and  nuts,  vari- 
ous grains,  etc.  Many  societies  have  been  formed  for 
this  purpose,  the  supporters  being  known  as  vegeta- 
rians, fruitarians,  etc.  Some  of  the  advocates  of  these 
theories  believe  that  in  their  practice  they  are  dispens- 
ing with  proteins.  This  is  not  a  fact,  for  protein  is  not 
confined  to  meats  and  eggs,  but  is  found  in  vegetables, 
often  in  large  amount.  Peas  contain  about  twenty  per 
cent  of  nitrogenized  food ;  some  of  the  cereals  are  also 
rich  in  proteins.  Yet  vegetarians  have  done  a  vast 
amount  of  good  by  furnishing  reliable  evidence  that  we 
eat  far  too  much  meat  and  that  this  practice  impairs 
digestion,  tends  to  make  those  who  are  intemperate  in 
this  direction  nervous  and  irritable,  and  later  in  life  is 
unquestionably  an  important  factor  in  causing  organic 
diseases  and  other  serious  ailments.  Conditions  do 
exist  where  a  generous  supply  of  meat  is  not  out  of 
place,  as  in  the  case  of  those  whose  work  involves  con- 
tinued severe  physical  exercise.  Unfortunately,  how- 
ever, a  full  diet  of  meat  is  commonly  partaken  of  by 
those  of  sedentary  habits. 

As  we  have  already  learned,  the  function  of  food  is 
not  limited  to  the  nourishment  of  the  body.  It  must 
also  generate  heat  and  energy,  as  fuel  does  for  the  en- 
gine. In  order  that  health  may  be  maintained  it  is  nec- 
essary that  the  body  shall  be  kept  at  a  temj>erature  of 
about  98.6°  F.  With  the  many  influences  which  af- 
fect the  human  system,  it  is  one  of  the  wonders  of 


92  GOOD  HEALTH 

nature  that  this  standard  is  mamtained ;  yet  this  is  the 
case,  for  while  food  furnishes  the  fuel  which  gener- 
ates the  heat,  means  are  provided  to  regulate  it.  No 
more  practical  or  interesting  illustration  of  the  latter 
can  be  given  than  the  protection  which  nature  extends 
in  this  way  in  the  case  of  firemen  or  stokers  who  feed 
the  furnaces  in  the  great  ocean  steamships  and  who 
are  often  subjected  to  a  temperature  of  125°  F. 
or  even  higher.  If  the  temperature  of  the  body  were 
raised  to  this  point,  death  would  quickly  follow.  Under 
these  extreme  conditions,  the  normal  temperature  of 
the  body  is  maintained  chiefly  by  profuse  perspiration 
which  neutralizes  the  external  heat  by  evaporation. 
Nature  can  continue  this  unusual  condition  only  for  a 
limited  time,  and  men  who  are  thus  employed  must  be 
frequently  relieved  by  others,  otherwise  death  or  seri- 
ous illness  may  occur  as  the  result  of  what  is  known 
as  ''heat-stroke. "  The  temperature  of  the  body  is 
often  raised  by  internal  causes,  such  as  infection,  and 
medical  and  surgical  treatment  is  required  to  assist 
nature  to  overcome  it. 

The  reduction  of  the  body  temperature  below  its 
normal  register  must  also  be  carefully  guarded  against, 
for  if  this  goes  too  far,  equally  serious  results  will  fol- 
low. Aside  from  disease,  this  condition  is  usually  the 
result  of  climatic  conditions  where  the  temperature  is 
very  low.  If  the  exposure  lasts  for  a  short  time  only 
and  the  person  is. in  good  health  and  well  clad,  he  is 
not  seriously  affected ;  but  when  long  exposure  is  con- 
templated, means  must  be  taken  to  prevent  injury  from 
this  cause.     In  the  Arctic  regions  where  the  tempera- 


FOOD  93 

ture  is  continually  very  low,  the  person  must  not  only 
be  provided  with  very  warm  clothing,  but  must  eat 
food  which  generates  the  greatest  amount  of  heat.  The 
diet  of  the  Esquimaux  is  largely  fat,  usually  in  the 
form  which  would  be  nauseating  to  an  inhabitant  of 
the  temperate  or  torrid  zone  and  which  would  cause 
great  discomfort  and  probably  disease. 

We  may  feed  an  engine  too  much  fuel,  or  use  fuel  of 
an  improper  kind.  So  may  we  take  more  food  than 
we  need  for  the  nourishment  of  the  body  and  the  gen- 
eration of  heat  and  energy,  or  we  may  partake  of  food 
which  is  deficient  in  nourishment,  difficult  to  digest 
and  disturbing  to  the  machinery  which  disposes  of  it. 

These  various  conditions  have  led  scientists  to  make 
a  most  careful  and  painstaking  investigation  concern- 
ing potential  energy,  or  value  of  the  various  forms  of 
food.  This  is  now  reckoned  by  calories.  In  plain 
words,  a  calory  represents  the  amount  of  heat  neces- 
sary to  raise  the  temperature  of  one  pound  of  water 
about  4°  F.  The  experiments  in  this  direction  are 
made  by  burning  the  various  articles  of  food  in  an 
apparatus  in  which  the  heat  generated  may  be  meas- 
ured. 

While  this  work  goes  far  to  establish  a  standard  by 
which  a  normal  diet  may  be  approximately  determined 
and  rendered  available  for  practical  use  and  to  furnish 
suggestion  as  to  the  character  and  amount  of  food  best 
fitted  for  our  nourishment,  it  must  be  borne  in  mind 
that  this  means  of  estimating  food  value  deals  with  the 
subject  largely  from  a  theoretical  standpoint.  The 
heat  developed  by  a  certain  form  of  food  in  experi- 


94  GOOD  HEALTH 

mental  or  laboratory  work  probably  does  not  corre- 
spond to  the  amount  of  heat  generated  by  it  in  the 
body,  for  here  it  is  subjected  to  various  changes  over 
which  we  have  little  or  no  control.  Besides,  every  per- 
son does  not  respond  in  the  same  way  to  the  heat- 
and  energy-producing  capacity  of  food. 

Not  only  have  scientists  determined  the  relative 
amount  of  proteins,  sugars  and  fats  in  the  various 
foodstuffs,  as  well  as  the  tissue  building  and  caloric, 
or  heat  and  energy,  value  of  these  articles,  but  esti- 
mates have  been  made  as  to  the  number  of  calories  we 
need  during  the  day  to  maintain  the  proper  nourish- 
ment of  the  body. 

It  is  well  known  that  persons  of  sedentary  habits 
do  not  need  as  much  food  as  those  who  perform  man- 
ual work  or  are  otherwise  physically  active.  Under 
the  former  conditions,  it  is  believed  that  food  repre- 
senting about  2,500  calories  is  sufficient  for  the  day's 
supply.  An  increase  in  this  amount,  however,  is  called 
for  to  sustain  a  person  engaged  in  continued  active 
exercise  or  at  hard  labor.  This  may  require  a  daily 
supply  of  4,000  to  5,000  calories.  Naturally  there  is 
some  difference  in  the  estimates  given  by  various  in- 
vestigators, for  the  scientific  deductions  regarding  this 
detail  of  the  subject  are  largely  theoretical. 

Valuable  tables  have  been  prepared  enabling  us  to 
make  practical  use  of  the  knowledge  above  referred  to, 
and  they  furnish  a  valuable  guide  in  the  selection  of  a 
healthful  and  serviceable  diet. 

It  may  be  said  concerning  the  relative  amount  of 
proteins,  sugars  and  fats  required  for  the  proper  main- 


FOOD  -  95 

tenance  of  the  body,  that  about  ten  to  twenty  per  cent 
should  be  proteins,  something  less  of  fat,  and  the  re- 
mainder, or  greatest  portion,  should  be  carbohydrates. 
The  latter  material  constitutes  the  most  important 
agent  in  the  generation  of  heat  and  energy,  aided  by 
fats,  although  they  have  practically  nothing  to  do  with 
the  repair  or  building  of  tissues ;  whereas  the  proteins 
are  alone  concerned  in  this  work,  and  contribute  com- 
paratively little  toward  the  production  of  heat  and 
energy  except  in  emergencies. 

The  accompanying  table  is  presented  as  a  means  of 
elucidating  what  has  just  been  said  regarding  this  part 
of  the  subject  of  nutrition,  and  is  of  practical  impor- 
tance in  showing  that  proteins  are  not  confined  to  meats, 
eggs,  etc.,  but  are  found  to  a  large  extent  in  vegetables 
and  cereals  and  that  proteins  in  the  latter  form  may 
often  be  used  as  a  substitute  for  meat.  The  great  eco- 
nomic value  of  this  is  apparent. 

It  is  important  in  a  general  way  that  the  public 
should  be  familiar  with  the  scientific  researches  above 
referred  to;  but  it  would  be  unwise  and  impractical 
for  a  person  to  depend  upon  these  data  for  the  ar- 
rangement of  a  diet  for  daily  use.  It  would  be  not 
only  largely  a  matter  of  theory,  but  it  would  lead 
to  all  sorts  of  experiments  and  produce  many  so- 
called  food  cranks.  It  must  be  borne  in  mind  that  in- 
stinctively each  race  of  people  knows  the  food  best 
adapted  for  its  use.  Besides,  the  appetite  of  a  healthy 
person  is  a  most  excellent  criterion  of  what  form  of 
food  is  best  for  him.  The  digestive  apparatus,  in  its 
acceptance  of  the  various  articles  of  diet  thrust  upon 


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98  GOOD  HEALTH 

it,  is  not  by  any  means  alike  in  everyone.  Many  per- 
sons include  milk  and  eggs  in  their  daily  menu  without 
the  slightest  digestive  disturbances,  while  others  can- 
not take  these  articles  of  food  without  great  discom- 
fort. Therefore,  while  they  are  among  the  most 
valuable  forms  of  nourishment,  it  is  often  unwise  to 
depend  upon  them  for  sustenance. 

Far  too  little  attention  has  been  given  to  this  phase 
of  the  subject.  If  a  person  is  in  normal  health,  the 
continued  repugnance  of  the  alimentary  tract  to  certain 
articles  of  food,  provided  they  are  properly  cooked, 
should  be  accepted  as  an  indication  that  other  forms  of 
nourishment,  having  about  the  same  tissue  building  and 
fuel  value,  should  be  substituted. 

It  is  commonly  believed  that  when  a  large  amount  of 
food  is  taken  the  portion  not  actually  required  at  that 
time  is  stored  up  for  future  use,  and  is  of  value  when 
waste  occurs  in  disease  or  other  disabling  conditions. 
While  in  a  measure  this  is  true  as  far  as  sugars  and 
fats  are  concerned,  there  is  sufficient  proof  that  it 
does  not  apply  to  proteins.  Furthermore,  when  pro- 
teins are  taken  in  excess,  they  cause  extensive  fermen- 
tative and  putrefactive  changes  in  the  intestinal  tract, 
and  not  only  lead  to  the  absorption  of  poisonous  prod- 
ucts into  the  system,  which  is  responsible  for  many  un- 
pleasant and  often  serious  conditions,  but  overtax  vari- 
ous organs  of  the  body. 

There  is  no  habit  more  destructive  to  health  and 
more  certain  to  cause  serious  results  than  overeating. 
Particularly  are  these  evils  manifest  late  in  life  in  the 
form  of  various  diseases.     Besides,  investigation  now 


FOOD  99 

under  way  is  likely  to  prove  that  intemperance 
in  eating  is  more  or  less  responsible  for  diseased 
blood-vessels,  which  lead  to  apoplexy.  It  is  not  diffi- 
cult to  understand  that  these  conditions  are  far  more 
common  among  the  well-to-do,  who  can  indulge  in 
overeating,  than  among  the  poorer  classes,  who  eat 
plain,  simple  but  nourishing  food,  and  less  of  it.  The 
overeating  of  meat  is  most  frequently  indulged  in,  for 
almost  everyone  who  can  afford  it  is  apt  to  consume 
too  much  of  it. 

It  will  require  but  little  study  on  the  part  of  each 
person  to  ascertain  not  how  much  he  can  eat,  but 
what  is  the  minimum  amount  of  food  required  to 
maintain  good  health.  The  reward  for  this  will  be 
extremely  gratifying,  for  it  will  go  far  to  prove  what, 
has  been  said  regarding  the  value  of  a  simple  diet. 

Before  leaving  this  part  of  the  subject  a  word  may 
be  said  concerning  the  use  of  condensed  foods  or  food 
extracts  as  a  substitute  for  the  ordinary  articles  of 
diet.  Some  of  the  arguments  in  favor  of  this  means 
of  nourishment  relate  to  the  very  greatly  reduced  bulk 
in  which  they  may  be  obtained,  the  small  capacity  re- 
quired for  transportation  and  the  fact  that  food  in 
this  form  is  not  so  apt  to  be  affected  by  climatic  condi- 
tions. There  is  no  doubt  that  in  emergencies  or  in 
certain  diseases  or  for  a  very  short  period  foods  pre- 
pared in  the  manner  above  referred  to  may  be  of  great 
value  in  sustaining  life,  but  they  are  unfit  for  continued 
use.  Those  who  believe  otherwise  are  unmindful  of 
the  fact  that  the  large  amount  of  material  we  eat  in 
order  to  obtain  a  small  percentage  of  proteins,  sugars 


100  GOOD  HEALTH 

and  fats — in  vegetables  for  instance — has  an  exceed- 
ingly important  function  of  its  own  in  stimulating  the 
alimentary  tract,  furnishing  certain  saits  and  in  other 
ways  is  of  great  importance  in  the  preservation  of 
health. 

It  is  sufficient  to  know  that  food  extracts  and  con- 
densed foods  should  not  be  depended  upon  in  place  of 
a  natural  diet.  Furthermore,  whole  grain  contains 
more  nourishment  than  when  the  envelope  or  husk  is 
removed.  A  striking  illustration  of  this  will  be  re- 
ferred to  in  the  consideration  of  rice  as  an  article  of 
food. 

Some  of  the  more  important  foodstuffs  call  for  spe- 
cial notice. 

Milk  may  be  regarded  as  the  most  valuable  form  of 
nutrition,  for  it  contains  practically  all  the  substances 
necessary  for  our  existence :  proteins,  sugars  and  fats, 
etc.  No  other  form  of  food  is  required  in  early  life, 
and  an  adult  may  subsist  on  it  for  a  while,  but  as  it 
consists  of  about  87  per  cent  of  water,  it  cannot  be 
depended  upon  indefinitely  to  maintain  the  health  of  a 
grown  person. 

The  various  products  of  milk  are  so  well  known 
that  they  require  only  brief  notice.  Cream  is  that 
portion  of  milk  which  is  rich  in  fat,  and  being  lighter 
than  milk  rises  to  the  surface.  When  the  cream  is  re- 
moved, skimmed  milk  is  left.  Butter,  which  amounts 
to  about  four  per  cent  of  milk,  is  abstracted  from  the 
cream  by  churning,  the  remaining  fluid  being  known 
as  "buttermilk."  Cheese  is  made  from  milk  by  coagu- 
lating the  casein  or  protein  substance  with  rennet  or 


FOOD  lor 

lactic  acid.  In  making  soft  cheese,  like  Brie  and  Cam- 
embert,  the  curd  is  simply  placed  in  molds,  while  hard 
cheese,  the  more  common  form,  is  subjected  to  pres- 
sure. Of  the  enormous  output  of  milk  in  the  United 
States,  three-quarters  of  it  is  used  for  butter  and 
cheese. 

Although  from  a  general  standpoint  milk  is  the  most 
important  article  of  diet,  it  is  also  responsible  for  more 
sickness  than  any  other  form  of  food,  for  it  is  com- 
monly taken  raw,  and  in  this  state  it  is  almost  impossi- 
ble to  avoid  some  form  of  contamination.  This  is  due 
chiefly  to  the  presence  of,  bacteria.  While  certain 
forms  of  these  germs  in  milk  may  excite  only  local 
trouble,  as  stomach  and  intestinal  affections  of  chil- 
dren, others  known  as  pathogenic  organisms  may 
transmit  infectious  diseases,  such  as  typhoid  fever  and 
diphtheria. 

It  is  not  difficult  to  understand  why  contamination 
occurs  when  we  consider  the  various  means  by  which 
this  may  take  place :  filthy  condition  of  the  cows  and 
hands  of  the  milker,  insanitary  stables  and  unclean 
receptacles  in  which  the  milk  is  contained  from  the 
time  it  is  drawn  until  it  is  consumed.  To  prevent  this 
contamination  is  the  problem  which  health  officials  are 
constantly  trying  to  solve. 

The  milk  supply  of  a  great  city  necessarily  comes 
from  many  sources  which  it  is  impossible  to  control 
satisfactorily.  For  instance,  New  York  City  consumes 
daily  over  2,000,000  quarts  of  milk  brought  from  all 
parts  of  the  country  within  a  radius  of  two  or  three 
hundred  miles,  much  of  it  from  dairies  which  are  not 


302  GOOD  HEALTH 

in  proper  sanitary  condition.  Therefore,  the  purity 
of  the  cow's  milk  in  its  natural  state  cannot  be  de- 
pended upon,  unless  a  dairy  and  its  methods  can  be 
Icept  under  personal  observation,  possible  only  where 
the  dairy  is  close  by.  There  are  important  advantages 
gained  in  this  way,  for  milk  in  its  natural  state  is  far 
more  valuable  as  an  article  of  diet  than  that  which  has 
been  "treated." 

In  order  that  milk  may  be  made  safe  without  being 
treated,  commissions  have  been  formed  in  some  of  the 
large  cities  to  inspect  and  keep  under  careful  observa- 
tion certain  dairies.  The  owners  of  these  dairies  enter 
into  an  agreement  to  carry  out  such  regulations  as  may 
be  prescribed  by  the  commissions  to  insure  proper 
sanitary  conditions  about  the  dairies  and  to  enforce 
clean  and  wholesome  methods  of  handling  the  milk 
from  the  time  it  is  drawn  until  it  reaches  its  destina- 
tion. In  return  the  commissions  recommend  this  milk 
for  general  use. 

This  is  known  as  "certified"  or  "inspected"  milk  and 
is  naturally  more  expensive,  and  hence  is  used  only 
by  a  small  proportion  of  the  public.  For  this  reason 
the  municipal  authorities  in  many  places  recommend 
or  require  the  pasteurization  of  milk;  while  in  others, 
little  action  or  interest  is  taken  in  this  important 
matter,  and  each  family  must  investigate  its  own  milk 
supply. 

While  boiling  is  certain  to  destroy  all  germs  con- 
tained in  the  milk  and  is  the  safest,  simplest  and  most 
effective  means  which  can  be  employed  in  emergen- 
cies, the  heat  required,  212°  F.,  renders  the  milk  less 


FOOD  103 

valuable  for  purposes  of  nutrition.  Therefore  a  more 
permanent  means  of  purification — pasteurization — has 
been  generally  accepted. 

Pasteurization  is  a  very  simple  process.  It  usually 
consists  in  subjecting  the  milk  to  a  temperature  of 
150°  F.,  for  twenty  minutes  and  then  replacing  it 
upon  the  ice.  This  temperature,  which  is  below  the 
boiling  point  and  cannot  be  depended  upon  to  kill  all 
forms  of  bacteria,  will  destroy  the  germs  of  tubercu- 
losis and  render  harmless  other  infectious  organisms 
which  may  be  present. 

Pasteurization  is  now  carried  out  on  a  very  large 
scale  by  dairymen  in  response  to  certain  municipal 
regulations.  It  may  also  be  easily  done  at  home  in  the 
following  manner:  The  milk  is  put  in  bottles  which 
are  tightly  closed,  sealed  and  placed  in  a  pan  and 
covered  with  water.  The  water  is  raised  to  a  tempera- 
ture of  150°  F.  and  kept  at  this  point  for  twenty 
minutes.  The  bottles  are  then  removed  and  placed  in 
the  icebox  close  to  the  ice,  and,  after  being  cooled,  the 
milk  is  ready  for  use. 

The  public  should  carefully  avoid  the  use  of  powders 
and  other  mixtures  advertised  as  preservatives  of  milk. 
These  are  not  equal  to  the  methods  just  referred  to, 
and  may  do  considerable  harm. 

The  public  should  also  be  warned  against  the  use  of 
what  is  termed  "dipped  milk";  that  is,  milk  which  is 
dispensed  from  cans  in  various  places.  This  is  always 
contaminated,  as  the  receptacle  is  opened  not  only 
when  a  sale  is  made  but  often  left  open  at  other  times. 

Many,  both  young  and  old,  are  unable  to  take  cow's 


104  GOOD  HEALTH 

tnilk,  as  it  curdles  or  ferments  too  quickly  on  coming 
in  contact  with  the  acid  secretions  of  the  stomach,  and 
is  often  the  cause  of  indigestion.  In  human  milk  the 
curd  forms  more  slowly,  therefore  it  is  far  better 
adapted  to  the  nourishment  of  the  infant.  When  it  is 
necessary  to  use  cow's  milk  at  this  period  of  life,  lime 
water  and  other  agents  are  added  to  prevent  the  rapid 
curdling.  Cow's  milk  is  easily  digested  by  the  calf,  as 
its  stomach  is  prepared  to  break  up  the  curd. 

In  the  Far  East  the  objection  to  animal  milk,  on  ac- 
count of  the  curdling  and  the  digestive  disturbances 
which  occur,  is  largely  overcome  by  fermenting  it  be- 
fore it  is  taken  into  the  stomach.  By  this  means  the 
curd  which  forms  is  broken  up  and  dissolved.  Kumyss 
is  an  illustration  of  this  and  is  now  well  known  in  this 
country. 

Other  forms  of  fermented  milk  are  also  extensively 
used  throughout  the  world  under  different  names 
with  the  most  satisfactory  results.  Besides,  the  acids 
which  are  formed  during  fermentation  are  believed  to 
prevent  to  a  great  extent  the  putrefactive  changes 
which  occur  in  the  intestinal  canal  from  which  so  many 
persons  suffer.  Milk  thus  treated  is  not  to  be  regarded 
as  medicated  and  may  be  taken  in  about  the  same 
quantity  as  ordinary  milk  if  it  is  pleasantly  received. 
If  not  promptly  used,  the  acid  fermentation  continues, 
and  these  products  become  too  sour  and  objectionable 
for  use.  While  the  addition  of  vichy  and  seltzer  water 
may  to  a  certain  extent  overcome  this,  it  is  far  better 
that  they  should  be  freshly  prepared,  particularly  when 
used  for  invalids. 


FOOD  105 

In  many  sections  of  the  East  but  little  else  besides 
fermented  milk  is  taken  for  food,  and  it  has  been  said 
that  a  hundred  years  is  not  an  extraordinary  age 
among  the  natives.  This  is  very  important  evidence 
that  nothing  more  surely  guarantees  the  prolongation 
of  life  than  a  proper  amount  of  simple  and  nutritious 
food,  particularly  that  which  will  cause  the  minimum 
amount  of  putrefactive  changes. 

As  kumyss  and  other  forms  of  fermented  milk  sold 
in  stores  are  comparatively  expensive,  their  use  is  nec- 
essarily restricted.  This  form  of  nourishment,  how- 
ever, should  be  familiar  to  every  household,  for  it  is 
very  valuable  and  refreshing  as  an  article  of  diet. 
Kumyss  may  easily  be  made  at  home  and  at  a  cost 
which  hardly  exceeds  that  of  milk.  The  following 
is  one  of  the  various  formulae : 

Before  preparing  the  kumyss,  bottles  for  its  reception 
should  be  made  ready;  beer,  citrate  of  magnesia  or 
other  bottles  having  the  patent  tight-fitting  cork  answer 
all  purposes.  These  should  be  carefully  cleaned  and 
left  in  boiling  water  for  five  minutes,  then  taken  out 
and  drained. 

For  the  first  experiment  put  two  quarts  of  milk  in  a 
porcelain  or  granite-ware  receptacle,  and  place  over  a 
slow  fire.  Add  one  level  tablespoonful  of  salt  and  two 
small  tablespoonfuls  of  granulated  sugar;  the  amount 
of  sugar  may  be  increased  or  decreased  as  it  is  desired. 

Dissolve  one-half  of  a  compressed  yeast  cake 
(Fleischmann)  in  half  a  teacup  of  water. 

Stir  the  milk  slowly  while  warming,  and  do  not  over- 
heat it;  when  lukewarm  add  the  dissolved  yeast  cake, 


io6  GOOD  HEALTH 

take  the  receptacle  off  the  fire  and  stir  the  contents 
slowly  to  mix  the  yeast  thoroughly.  Then  fill  the  bot- 
tles only  just  above  the  shoulder,  leaving  a  space 
which  will  prevent  the  gases  formed  by  fermentation 
breaking  the  glass. 

When  filled,  lay  the  bottles  in  a  warm  place  and 
cover  with  a  blanket  for  about  ten  hours,  turning  each 
bottle  half  way  every  hour  or  two;  at  the  expiration 
of  this  period  lay  the  bottles  in  the  icebox  until  thor- 
oughly cooled,  when  they  are  ready  for  use.  Turn 
over  the  bottles  of  kumyss  in  the  icebox  once  each  day. 

Considerable  patience  is  required  until  the  details 
connected  with  the  manufacture  of  this  article  are  fully 
mastered.  It  must  be  specially  borne  in  mind  that 
kumyss,  like  champagne,  contains  a  gas  which  is  par- 
ticularly lively,  and  therefore  the  bottles  must  be  care- 
fully opened.  A  clean  towel  placed  over  the  mouth  of 
the  bottle  when  being  opened  will  protect  one's  cloth- 
ing from  the  kumyss  which  escapes  with  considerable 
force. 

In  localities  where  the  conditions  of  the  dairies  from 
which  the  milk  supply  is  obtained  are  known  to  be 
sanitary,  the  question  of  pasteurization  need  not  be 
raised,  for  it  may  be  repeated  that  this  process  does 
to  a  certain  extent  affect  the  food  value  of  milk. 

Wherever  the  municipal  health  authorities  enforce 
strict  regulations  concerning  the  public  milk  supply  it 
is  only  necessary  that  each  family  should  deal  with 
a  milkman  who  is  known  to  be  reputable,  who  is  care- 
ful in  his  selection  of  the  milk  he  sells,  and  who  com- 
plies faithfully  with  municipal  regulations. 


FOOD  107 

Milk  is  best  preserved  by  a  low  temperature  between 
^2°  (freezing)  and  50°  F.  While  this  does  not  de- 
stroy the  bacteria  contained  in  the  milk,  it  renders 
them  practically  harmless  for  the  time  being,  and  the 
milk  does  not  become  sour,  although  later  it  may  be- 
come unfit  for  use  in  other  ways.  Therefore  it  is  very 
necessary  that  every  home  should  contain  a  properly 
constructed  icebox,  for  the  preservation  not  only  of 
milk,  but  of  other  food  products  which  also  decompose 
rapidly  in  warm  weather. 

The  meat  we  eat  is  obtained  from  animals,  princi- 
pally cattle  and  sheep,  which  are  herbivorous,  and  as 
a  rule  are  not  subjected  to  physical  work.  Horses  are 
given  proteins,  usually  in  the  form  of  oats,  corn  and 
hay,  to  increase  their  muscular  power  and  efficiency, 
and  for  this  and  other  reasons  their  meat  is  coarser 
and  not  as  palatable  as  that  of  the  above  mentioned 
animals. 

It  will  be  observed  in  the  accompanying  table  that 
a  pound  of  fresh  meat  is  equal  to  1,200  or  1,500  calo- 
ries, and  contains  from  17  to  20  per  cent  of  proteins, 
about  the  same  amount  of  fat  and  no  carbohydrates; 
lamb  has  about  the  same  constituents.  Therefore  the 
value  of  meat  as  protein  food  is  apparent. 

Meat  is  sometimes  contaminated  or  diseased,  and 
under  these  conditions  its  use  may  be  followed  by  un- 
pleasant or  dangerous  results.  This  applies  chiefly  to 
hog  meat,  and  occasionally  to  veal.  It  may  be  due  to 
chemical  changes  known  as  "ptomaine  poisoning,"  or 
the  presence  of  certain  forms  of  bacteria  and  parasites. 
Poisoning  from  this  source  occurs  in  sections  of  the 


i68  GOOD  HEALTH 

world  where  food  is  eaten  uncooked  or  only  slightly 
cooked.  These  results  may  be  prevented  by  subjecting 
the  meat  to  a  sufficiently  high  degree  of  heat  to  kill 
the  bacteria  and  parasites  which  are  present.  Protec- 
tion against  the  danger  from  this  source  is  usually  se- 
cured by  the  various  methods  of  cooking  employed  in 
this  country,  although  when  the  center  of  the  meat  re- 
tains its  redness  after  cooking  it  is  questionable  if  the 
proper  degree  of  heat  has  been  reached. 

Beef  and  lamb  or  mutton  are  so  seldom  contam- 
inated in  the  manner  above  described  that  it  should  not 
deter  those  who  prefer  these  meats  rare  from  contin- 
uing their  use,  provided  care  is  observed  in  purchas- 
ing them. 

It  would  be  out  of  place  and  unnecessary  to  recite 
in  this  book  the  various  means  by  which  meat  may  be 
contaminated.  As  a  protection  against  this  condition, 
each  family  should  give  proper  time  and  attention  to 
the  selection  of  a  dealer  who  purchases  his  meat  care- 
fully and  provides  proper  sanitary  receptacles  for  it 
while  it  is  in  his  possession. 

Poultry  is  more  easily  digested  and  less  stimulating 
than  meat,  and  is  therefore  more  suitable  for  con- 
valescents and  those  with  weak  digestive  apparatus. 
Chickens  and  turkeys  have  about  the  same  percentage 
of  proteins  and  fats  as  beef  and  lamb ;  however,  their 
caloric  or  fuel  value  is  somewhat  less.  Game,  such  as 
quail  and  partridge,  is  tender  and  easily  digested.  The 
practice  of  keeping  game,  however,  for  a  prolonged 
period  for  the  purpose  of  developing  certain  flavors 
cannot  be  regarded  as  wholesome. 


FOOD  109 

Fish  is  more  digestible,  but  has  less  protein  and  far 
less  fat  than  meat,  and  is  therefore  less  stimulating  and 
supporting  than  meat.  A  pound  equals  about  400 
calories.  Fish  must  be  eaten  fresh,  for  it  decomposes 
rapidly  and  in  this  condition  is  absolutely  unfit  for 
use. 

Oysters  are  nutritious,  although  they  contain  even 
less  protein  than  fish,  and  but  a  very  small  percentage 
of  fat;  therefore  their  caloric  value  is  very  low.  They 
are  easily  digested,  but  they  must  also  be  eaten  fresh. 
Oysters  may  be  polluted  by  sewage  if  they  are 
grown  in  waters  which  are  greatly  contaminated.  How- 
ever, it  is  quite  probable  that  the  dangers  from  this 
source  are  greatly  exaggerated  and  may  be  avoided  if 
reasonable  care  is  taken  to  ascertain  whence  the  oysters 
came.  In  many  instances  their  beds  are  far  removed 
from  probable  contamination. 

Lobsters  and  crabs  contain  considerable  protein,  are 
very  palatable  and,  like  oysters,  have  very  little  fat. 
They  are  fit  to  eat  only  when  fresh;  serious  results 
may  follow  a  disregard  of  this  rule.  This  is  also  par- 
ticularly true  of  mussels,  and  it  is  much  safer  to  ex- 
clude them  as  articles  of  diet. 

It  is  hardly  necessary  to  refer  to  the  importance  of 
eggs  as  an  article  of  food,  for  their  value  is  well 
known.  The  white  of  an  egg,  or  albumen,  is  the  pro- 
tein substance,  and  the  yolk  is  composed  largely  of 
fat ;  this  makes  an  egg  an  exceedingly  valuable  mixed 
diet.  One  good-sized  egg  is  equal  to  about  100  calo- 
ries, and  contains  13  per  cent  of  protein  and  10  per 
cent  of  fat. 


no  GOOD  HEALTH 

While  eggs  cannot  be  adulterated,  we  are  often  de- 
ceived as  to  their  freshness,  for  they  may  be  kept  in- 
definitely by  preventing  air  from  passing  through  the 
shell.  This  is  accomplished  by  packing,  by  immersion, 
or  by  coating  them  with  an  impervious  material,  such 
as  wax.  Various  tests  are  employed  to  detect  stale 
or  bad  eggs,  but  these  cannot  be  depended  upon  except 
by  an  expert.  It  is  far  more  important  to  have  a  re- 
liable source  of  supply. 

Butter  is  the  milk  fat  and  has  already  been  referred 
to.  Butter  is  more  palatable  than,  and  far  superior  to, 
all  other  forms  of  fat  for  nourishment  of  the  body,  and 
far  too  little  of  it  is  used  even  when  the  question  of 
expense  is  not  a  factor  to  be  considered.  Butter  is 
very  easily  digested,  and  is  a  particularly  important 
article  of  diet  to  those  who  are  weak  and  badly 
nourished  and  suffering  from  wasting  diseases. 
Butter  contains  over  80  per  cent  of  fat  and  only 
one  per  cent  of  protein;  therefore,  its  fuel  value  is 
very  great.  A  pound  of  butter  equals  nearly  3,500 
calories. 

Cheese  is  very  rich  both  in  fats  and  proteins.  Among 
the  poorer  classes  in  Europe  it  often  forms  a  large  part 
of  the  diet.  While  it  is  very  nourishing  and  particu- 
larly palatable,  it  is  often  hard  to  digest,  and  there 
are  few  who  can  eat  a  large  amount  of  it  without  some 
disturbance  of  digestion. 

The  importance  of  cereals  as  food  may  in  a  measure 
be  indicated  by  their  general  use  throughout  the  world. 
Wheat,  corn  and  oats  are  the  most  valuable  articles  of 
this  class.    It  is  from  the  cereals  or  grain  that  we  are 


FOOD  III 

chiefly  supplied  with  starches  which  furnish  not  only 
nourishment,  but  a  large  part  of  the  heat  and  energy 
generated  in  the  body. 

The  various  ways  in  which  wheat  may  be  used  for 
food  are  too  well  known  to  call  for  extended  comment. 
Bread,  which  is  made  largely  of  wheat  flour,  is  very 
properly  regarded  as  the  ''staff  of  life,"  for  wheat  con- 
tains both  nitrogenized  and  non-nitrogenized  sub- 
stances, is  easily  grown  and  less  expensive  than  many 
other  articles  of  diet. 

The  great  value  of  oatmeal  as  an  article  of  food  is 
far  from  being  fully  appreciated.  It  has  been  stated 
that  a  pound  of  oatmeal  is  as  valuable  as  two  pounds 
of  meat.  There  is  considerable  truth  in  this  saying, 
and  it  is  only  necessary  to  examine  the  table  contained 
in  this  chapter  to  recognize  the  richness  of  oatmeal 
in  proteins  and  other  substances  required  for  a  mixed 
diet.  We  may  turn  to  the  horse  for  evidence  as  to  its 
value  in  furnishing  power  and  endurance.  Oatmeal 
contains  about  13  per  cent  of  proteins,  6  per  cent  of 
fat  and  at  least  65  per  cent  of  carbohydrates — almost 
an  ideal  food.  The  fuel  value  of  a  pound  of  oatmeal 
is  given  as  1,700  calories.  The  economical  value  of 
oatmeal  is  readily  apparent. 

Formerly  oatmeal  was  improperly  milled.  This  has 
been  overcome  by  new  and  greatly  improved  processes, 
but  the  fact  remains  that  oatmeal  is  not  as  a  rule  prop- 
erly or  sufficiently  cooked  for  the  table.  Because  of 
this  it  is  often  served  in  a  slimy,  sticky  and  unpala- 
table condition.  Every  housewife  should  study  how 
to  make   this   extremely   important   food   a   favorite 


112  GOOD  HEALTH 

article  of  diet,  for  its  value  is  as  great  in  the  homes  of 
the  rich  as  among  the  poor. 

Although  probably  one-third  of  the  population  of 
the  earth  subsists  on  rice,  it  is  poor  both  in  proteins 
and  fats,  and  does  not  provide  the  important  elements 
of  nutrition  which  are  found  in  other  cereals. 

Some  very  interesting  results  have  been  obtained 
in  connection  with  the  investigation  of  beriberi,  a  dis- 
ease evidently  due  to  malnutrition.  It  is  largely  preva- 
lent in  Japan,  the  Philippines,  and  other  sections  of 
the  world  where  rice  is  the  principal  article  of  diet, 
particularly  among  the  poorer  classes. 

These  researches  have  shown  that  beriberi  is  un- 
doubtedly caused  by  a  diet  of  polished  rice,  that  is, 
rice  from  which  the  outside  covering  or  shell  has  been 
removed.  It  has  been  shown  that  this  covering  is  the 
most  nourishing  part  of  the  grain.  The  proof  of  this 
lies  in  the  fact  that  since  the  whole  rice  has  been  used 
in  the  places  above  referred  to,  beriberi  is  rapidly 
disappearing. 

This  clearly  shows  that  we  should  not  depend  upon 
any  one  article  of  diet,  for  it  allows  too  little  margin 
upon  which  to  maintain  health,  even  if  it  is  rich  both  in 
nitrogenized  and  non-nitrogenized  substances,  and  that 
a  mixed  diet  is  necessary  for  the  proper  nourishment 
of  the  body. 

Peas  and  beans  are  rich  in  fats  and  proteins.  A 
good  dish  of  soup  made  from  either  of  these  articles, 
makes  an  excellent  meal. 

Although  deficient  in  fats  and  proteins,  potatoes 
form  a  very  valuable  article  of  diet,  for  they  contain 


FOOD  113 

a  large  amount  of  starchy  food.  Besides,  the  acid 
juice  of  the  potato  is  of  special  value,  for,  in  common 
with  other  vegetable  and  fruit  acids,  it  supplies  a  ma- 
terial which  the  system  must  have,  and  without  which 
certain  conditions  of  malnutrition  are  very  apt  to  oc- 
cur. Scurvy,  an  excellent  illustration  of  this,  was  com- 
mon among  the  crews  of  sailing  vessels  years  ago 
when  voyages  were  long  and  potatoes  and  other  acid- 
ulated foods  were  not  available.  This  does  not  now 
occur,  for  the  law  requires  that  outgoing  vessels 
shall  be  supplied  with  a  sufficient  quantity  of  lime  juice 
or  other  acids  or  acidulated  foods  to  prevent  such  a 
condition.  Besides,  slow  sailing  vessels  are  now  being 
supplanted  by  steamships  which  make  comparatively 
quick  trips,  and  whose  crews  are  not  deprived  of 
proper  food. 

It  is  commonly  believed  that  fruit  is  valuable  as 
food.  This  is  not  true,  for  while  it  is  exceedingly  pal- 
atable, refreshing  and  more  or  less  stimulating  to  the 
digestive  apparatus,  largely  from  the  residue  which  it 
contains,  it  is  with  few  exceptions,  such  as  the  banana, 
deficient  in  nourishment,  for  it  is  composed  chiefly  of 
water.  Its  value  depends  chiefly  upon  its  delicious  and 
refreshing  acid  juices,  particularly  when  the  fruit  is 
fresh  and  clean. 

Persons  are  differently  affected  by  fruit,  and  the  ex- 
tent to  which  it  may  be  eaten  should  be  decided  by  the 
individual.  Some  can  eat  apples  without  any  distress ; 
others  are  unpleasantly  affected  by  this  fruit.  Under 
the  latter  conditions  they  should  be  avoided.  Oranges 
contain  a  large  amount  of  indigestible  material.   This 


114  GOOD  HEALTH 

is  recognized  where  oranges  grow,  and  the  natives  very 
skillfully  extract  the  juice  and  the  soft  pulp  and  throw 
the  remainder  away. 

Lemon  juice  is  often  used  in  large  quantities  for  an 
extended  period,  sometimes  to  reduce  the  weight  of 
the  body.  While  some  may  follow  this  practice  with 
apparently  no  ill  effects,  or  even  with  benefit,  the  con- 
tinued use  of  lemon  juice,  particularly  in  large 
amounts,  is  injurious,  especially  in  connection  with 
the  teeth  and  digestive  organs. 

From  this  we  may  learn  that  while  fruit  is  very  re- 
freshing and  by  supplying  acid  juices  and  stimulating 
the  intestinal  tract  forms  a  very  important  part  of  our 
diet,  it  must  not  be  used  as  a  substitute  for  more  nour- 
ishing substances. 

It  is  hardly  necessary  to  speak  of  the  frequency  with 
which  older  persons  as  well  as  children  are  made  ill 
by  eating  fruit,  particularly  that  which  is  stale  and  un- 
ripe. This  occurs  more  often  among  the  poorer  classes 
and  in  cities,  where  the  supply  is  obtained  largely  from 
street  vendors.  Under  these  conditions  the  fruit  is 
often  not  only  unripe  or  decayed,  but  is  also  quite 
liable  to  be  infected  by  dust  and  filth  from  the  street. 
It  may  also  be  contaminated  by  the  dirty  hands  or 
cleaning  cloths  of  the  vendors  who  frequently  take 
home  the  supply  left  over  at  the  end  of  the  day's  sale 
for  the  next  day's  business.  No  greater  or  more  practi- 
cal charity  could  be  inaugurated  than  the  establishment 
throughout  the  tenement  house  districts  of  depots 
where  fresh,  clean  fruit,  as  well  as  properly  made  ice 
cream  and  the  so-called  soft  drinks  could  be  supplied 


FOOD  115 

at  a  low  cost.  This  would  go  far  to  overcome  the  dan- 
gers which  often  follow  the  consumption  of  stale  and 
impure  products. 

PREPARATION   OF  FOOD 

The  value  of  food  depends  largely  upon  the  manner 
in  which  it  is  prepared  for  digestion  by  cooking  and 
mastication.  The  former  process  properly  carried  out 
renders  meat  and  vegetables  not  only  more  palatable, 
but  far  more  digestible  by  breaking  up  the  fiber.  In 
the  raw  state  these  articles  are  rough  and  stringy,  and 
practically  unfit  to  eat.  Cooking  also  destroys  infec- 
tious germs  which  may  be  concealed  in  the  food. 

A  word  may  be  said  as  to  the  various  methods  and 
results  of  cooking.  In  dealing  with  meat  it  is  some- 
times desirable  that  it  should  not  only  be  cooked  suffi- 
ciently to  make  it  tender,  but  that  its  nourishing  and 
savory  juices  should  not  be  allowed  to  escape.  Roast- 
ing, broiling  and  grilling  secure  this  result,  for  the  in- 
tense heat  which  is  at  first  applied  quickly  coagulates 
and  hardens  the  surface,  and  to  a  large  extent  prevents 
the  juices  from  running  off.  On  the  other  hand,  boil- 
ing or  stewing  is  for  the  purpose  of  extracting  the 
nourishing  juices  from  meat  or  other  articles  of  food. 
This  is  done  by  placing  the  food  in  a  receptacle  con- 
taining cold  water  and  raising  the  temperature  to  the 
boiling  point,  and  maintaining  this  for  some  time.  In 
this  process  both  meats  and  vegetables  are  usually  cut 
into  small  pieces,  in  order  that  the  nourishment  and 
flavors  may  be  more  easily  extracted. 

There  is  one  method  of  cooking  which  is  less  de- 


ii6  GOOD  HEALTH 

sirable  than  others ;  i.  e.,  frying.  In  this  way  the  heat  is 
applied  through  the  medium  of  fat  or  oil  which  pen- 
etrates the  food  and  renders  it  less  digestible  than 
other  methods  of  cooking. 

One  of  the  commonest  errors  in  the  preparation  of 
food  is  the  imperfect  cooking  of  breadstuff s  and  cake, 
which  renders  them  soggy  and  heavy.  Under  these 
conditions  it  is  very  difficult  for  the  digestive  fluids  to 
penetrate  the  mass,  and  the  food  value  is  not  only 
diminished,  but  digestion  is  seriously  interfered  with. 

DISTRIBUTION   OF   MEALS 

There  are  many  theories  regarding  the  proper  time 
for  eating  and  the  number  of  meals  which  should  be 
taken  each  day.  The  various  opinions  and  recommen- 
dations which  are  offered  on  this  subject  denote  rather 
individual  preference,  and  cannot  always  be  accepted 
for  general  guidance. 

It  is  a  modern  and  very  common  practice  to  take  for 
breakfast  a  small  portion  of  fruit,  a  roll  and  a  cup  of 
coffee,  and  nothing  more  until  noon  or  later  in  the  day. 
This  is  based  upon  the  theory  that  upon  rising  in  the 
morning  the  digestive  apparatus  is  not  prepared  to 
deal  with  a  full  meal  and  to  assimilate  it  properly. 
This  theory  is  without  the  least  reasonable  or  logical 
foundation.  If  a  person  is  in  a  normal  condition,  the 
digestive  organs  should  be  at  their  highest  point  of  effi- 
ciency in  the  morning,  as  the  work  of  the  preceding 
day  has  been  followed  by  ten  or  twelve  hours  of  rest. 
Indeed  there  is  no  condition  which  more  clearly  indi- 
cates normal  health  than  a  good  appetite  upon  rising. 


FOOD  117 

Breakfast  should  he  the  best  meal  of  the  day.  Ill 
health,  dissipation  or  overeating  will  of  course  inter- 
fere with  this. 

Like  an  engine,  the  body  must  have  fuel  to  run  it. 
In  the  morning  the  day's  work  begins,  and  good  nutri- 
tious food  must  be  supplied  in  order  that  the  various 
functions  of  the  body  may  be  properly  performed.  A 
cup  of  coffee  and  a  roll  do  not  meet  this  requirement, 
particularly  during  the  cold  weather  when  the  body 
needs  material  not  only  for  food,  but  also  for  the  gen- 
eration of  heat.  The  fact  that  many  follow  this  course 
and  apparently  do  not  suffer  from  it  is  no  indication 
that  it  is  a  healthful  and  reasonable  method  to  adopt, 
for  it  is  not.  It  is  detrimental  to  health  and  unfits  a 
person  for  proper  work  during  the  day. 

At  noontime  the  business  of  the  day  has  reached  its 
most  active  stage.  The  meal  at  this  point  should  be 
small  and  should  consist  of  articles  which  are  easily 
digested.  If  a  heavy  meal  is  taken,  an  increased 
amount  of  blood  is  required  for  the  digestive  tract  to 
perform  its  function,  and  as  this  is  withdrawn  largely 
from  the  brain,  it  materially  interferes  with  the  work 
of  this  organ.  Under  these  conditions  a  person  is  apt 
to  become  sleepy  and  inactive. 

There  are  many  who  take  no  luncheon  and  feel  much 
better  for  it,  and  this  is  not  unreasonable  if  a  hearty 
breakfast  has  been  eaten,  but  not  otherwise.  On  the 
whole  it  is  probably  better  to  take  a  small  amount  of 
very  light  and  easily  digestible  nourishment  at  the  noon 
hour.  Later  in  the  day  the  system  naturally  becomes 
reduced  in  power,  and  digestion  is  not  so  easily  per- 


ii8  GOOD  HEALTH 

formed  unless  there  is  plenty  of  exercise;  therefore 
a  bountiful  meal  in  the  evening,  consisting  of  meat  and 
other  substantial  foodstuffs  is  fortunately  not  required 
except  by  those  who  perform  prolonged  manual 
labor. 

Custom  and  experience  have  ordained  that  we  shall 
eat  three  meals  during  the  day.  It  is  quite  unlikely 
that  this  arrangement  could  be  improved  upon.  How- 
ever, it  is  the  character  of  the  food  we  eat  and  the 
danger  of  intemperance  in  eating  that  demands  the 
more  careful  consideration.  Overeating  applies  rather 
to  adults ;  for  with  children  a  very  liberal  and  nourish- 
ing diet  is  needed  to  provide  not  only  for  present  pur- 
poses, but  also  for  increased  growth.  It  is  advisable 
that  young  children  be  fed  oftener  than  adults. 

There  are  those  who  omit  breakfast  for  the  purpose 
of  reducing  weight.  This  not  only  does  not  in  itself 
produce  the  desired  effect,  but  is  an  unhealthful  expe- 
dient. It  is  exercise  with  a  diminished  amount  of  food 
properly  distributed  over  the  day,  rather  than  a  reduc- 
tion in  the  meals,  which  may  be  depended  upon  to 
lower  a  person's  weight.  Besides,  it  must  be  remem- 
bered that  while  persons  are  depriving  themselves  of 
food  for  this  purpose,  they  may  do  it  to  such  an  ex- 
tent that  the  organs  will  not  receive  sufficient  nourish- 
ment to  perform  properly  their  functions,  and  sooner 
or  later  unpleasant  or  serious  results  may  follow. 

REDUCTION   OF  WEIGHT 

The  great  desire  on  the  part  of  some  people  to  re- 
duce their  weight  has  been  taken  advantage  of  by  char- 


FOOD  119 

latans,  who  offer  for  sale  all  sorts  of  nostrums  for  this 
purpose.  Unpleasant  and  injurious  results  very  often 
follow  the  use  of  these  agents,  for  the  body  cannot 
with  impunity  be  tampered  with  in  the  drastic  and  per- 
nicious manner  involved  in  such  treatment. 

Fortunately  a  person,  if  so  disposed,  may  reduce  his 
weight  without  resort  to  uncomfortable  and  dangerous 
practices.  During  recent  years  the  increased  knowl- 
edge which  has  come  to  us  concerning  the  chemistry 
of  food  products  and  their  relative  nutritive  value  has 
offered  simple  and  healthful  means  by  which  this  result 
may  be  obtained,  largely  by  a  proper  regulation  of  the 
diet. 

Fully  ninety  per  cent  of  those  who  are  fat  or  corpu- 
lent, particularly  those  in  advanced  years,  have  dis- 
obeyed the  law  of  nature  by  the  abuse  of  the  digestive 
system.  This  has  been  brought  about  through  overin- 
dulgence in  food  and  drink,  especially  fats  and  car- 
bohydrates, and  the  want  of  proper  exercise.  There- 
fore, this  condition  cannot  be  attributed  wholly  to  in- 
creasing age,  for  the  symmetry  and  grace  of  the  body 
may  be  indefinitely  preserved  if  it  has  been  properly 
cared  for. 

In  the  reduction  of  the  body  weight  by  healthful 
means,  two  things  are  imperative :  a  proper  diet  con- 
taining a  minimum  amount  of  fats  and  carbohydrates 
and  a  sufficient  amount  of  exercise,  preferably  walking. 
The  value  of  both  these  hygienic  measures  will  be 
fully  discussed  in  a  later  chapter  and  the  table  has 
been  introduced  in  this  chapter  (pages  96-97)  to  per- 
mit the  selection  of  articles  of  food  either  rich  or  defi- 


120  GOOD  HEALTH 

t 

dent  in  proteins  or  carbohydrates  according  to  the 
needs  of  the  occasion. 

While  a  rigid  diet  for  reduction  of  weight,  which 
eliminates  all  foods  known  to  contain  a  large  amount 
of  fats  and  sugar,  is  justifiable  for  a  period  sufficient 
to  overcome  obesity,  it  should  not  be  carried  too  far  or 
too  long,  for  we  thrive  best  upon  a  mixed  diet,  and 
if  this  is  properly  adjusted  and  suffi'cient  exercise 
is  taken — a  most  important  consideration — there  is 
no  reason,  unless  some  constitutional  trouble  ex- 
ists, why  overweight  should  occur.  It  must  be  re- 
membered that  too  little  of  fats  and  carbohydrates 
may  deprive  the  system  of  sufficient  nourishment 
to  maintain  properly  the  functions  and  heat  of  the 
body. 

A  word  may  also  be  said  in  regard  to  alcoholic 
drinks  in  connection  with  obesity,  for  while  in  them- 
selves they  may  to  a  certain  extent  increase  the  weight 
of  the  body  they  do  this  more  directly  by  causing  an 
abnormal  appetite. 

A  little  more  definite  information  may  be  imparted 
as  far  as  the  reduction  of  body  weight  is  concerned  by 
stating  that  such  articles  as  bread  and  butter,  milk,  po- 
tatoes, cereals  rich  in  carbohydrates,  are  the  foods  first 
proscribed,  and  are  to  be  eliminated  or  used  only 
sparingly. 

On  the  other  hand,  one  may  eat  all  kinds  of  lean 
meat,  excepting  hog  meat,  which  is  largely  composed 
of  fat.  In  addition  fish  and  oysters  may  be  added  to 
this  list  as  well  as  green  vegetables,  the  latter  not  only 
for  their  nutritive  value  but  also  for  the  large  amount 


FOOD  121 

of  residue  they  contain  which  stimulates  the  intestinal 
tract  and  prevents  constipation. 

Fruits,  with  the  exception  of  bananas  and  others 
which  contain  a  large  amount  of  starch,  may  be  eaten, 
but  rather  for  their  refreshing  effect  due  to  the  acid 
juices.  As  a  rule  they  cannot  be  depended  on  for 
nourishment.  With  these  suggestions  each  one  may, 
by  consulting  the  accompanying  table,  prepare  a  diet 
which  if  persevered  in  and  combined  with  walking  is 
quite  sure  to  reduce  the  body  weight. 


CHAPTER  VI 

DISPOSAL   OF   WASTE 

SEWAGE 

No  part  of  the  subject  of  sanitation  has  been  studied 
more  exhaustively  than  that  which  relates  to  the  dis- 
posal of  waste  matter,  particularly  human  excrement, 
for  through  the  medium  of  infectious  germs  found  in 
the  latter  refuse,  dangerous  diseases  are  transmitted 
from  one  person  to  another. 

The  natural  means  of  dealing  with  waste  matter 
and  sewage  is  to  return  it  to  the  soil  whence  it  came 
in  such  a  way  that  it  may  be  used  as  a  fertilizer  and 
enrich  the  ground  without  transmitting  infection  to  liv- 
ing beings.  This  method  is  practised  in  various  sec- 
tions of  the  world,  and  there  is  little  doubt  that  in  the 
future  it  will  command  more  serious  and  widespread 
consideration. 

The  waste  or  refuse  matter  to  be  disposed  of  in- 
cludes fecal  matter,  or  discharges  from  the  bowels, 
urine,  slops,  washings,  filth  of  animals,  refuse  from 
stables  and  outhouses  and  also  street  dirt.  In  addition 
there  are  innumerable  other  forms  of  waste  in  con- 
nection with  various  trades  and  factories.  It  is  neces- 
sary that  this  material  shall  be  promptly  disposed  of 

122 


DISPOSAL  OF  WASTE  123 

in  order  to  prevent  offensive  odors  and  possible  trans- 
mission of  infectious  germs. 

The  subject  of  waste  disposal  interests  both  city  and 
country.  In  cities  and  towns  the  water  carriage  sys- 
tem is  employed  for  the  removal  of  house  and  street 
waste  and  filth.  This  system  involves  the  use  of  large 
underground  main  pipes,  or  street  sewers,  which  con- 
duct the  waste  matter  to  a  river  or  some  body  of 
water  for  disposal.  The  individual  buildings  or  prem- 
ises are  connected  with  the  street  sewers  by  house 
drains,  which  in  their  turn  receive  the  waste  from 
sinks,  basins,  bathtubs  and  waterclosets  located  in  the 
different  apartments  of  the  building. 

Although  this  method  is  in  general  use  throughout 
the  world,  it  often  becomes  an  agent  of  infection  by 
polluting  bodies  of  water  into  which  the  sewage  is 
discharged,  and  which  are  sometimes  used  for  drink- 
ing purposes.  To  prevent  this,  various  means  are  em- 
ployed whereby  the  sewage,  before  it  reaches  its 
ultimate  destination  in  some  body  of  water,  is  treated 
either  chemically  or  by  filtration.  The  object  of  this 
is  to  destroy  the  infectious  bacteria  or  germs  and  thus 
prevent  the  contamination  of  water  which  may  be  used 
for  drinking  purposes.  However,  these  methods  of 
purification  cannot  be  depended  upon  for  protection. 

The  means  of  waste  disposal  employed  in  the  coun- 
try, where  there  is  no  water  carriage  system,  consists 
of  privy  vaults,  cesspools  and  sometimes  septic  tanks. 
However,  a  large  part  of  the  waste  matter  is  deposited 
on  the  ground  to  be  disposed  of  in  natural  ways. 

The  usual  drainage  of  a  modern  dwelling  house  or 


1 124  GOOD  HEALTH 

other  building  in  a  built-up  community,  consists  of 
one  or  more  lines  of  waste  and  soil  pipes,  depending 
upon  the  capacity  and  needs  of  the  structure.  These 
pipes  are  made  of  iron,  the  waste  pipes  being  two 
inches  and  the  soil  pipes  four  inches  in  diameter.  The 
joints  of  these  pipes  are  sealed,  or  caulked,  with  lead 
to  prevent  the  escape  of  offensive  fluids  or  gases. 

The  waste  pipes  connect  with  the  basins,  tubs,  sinks 
and  small  receptacles  throughout  the  house,  while  the 
soil  pipes  connect  with  the  waterclosets.  Under  each 
fixture  there  is,  or  should  be,  a  curved  pipe  somewhat 
similar  in  appearance  to  the  letter  S,  known  as  a 
"trap,"  the  function  of  which  is  to  hold  water  to  a  cer- 
tain level  in  the  bend  in  order  to  prevent  the  entrance 
of  sewer  gases  or  offensive  odors  into  the  apartment 
through  the  fixture.  If  a  number  of  these  are  con- 
nected with  the  same  upright  line  of  waste  or  soil  pipe, 
the  discharge  and  force  of  descending  water  or  waste 
from  a  sink  or  watercloset  might  suck  out,  or  siphon 
off,  the  water  in  the  traps  of  another  fixture  on  the 
same  line ;  therefore,  main  soil  and  waste  pipes  are  ex- 
tended four  or  five  feet  above  the  roof  of  the  building 
with  the  top  open  and  protected  against  the  entrance  of 
foreign  matter  by  a  cap  or  cover  which  does  not  fit  so 
close  as  to  prevent  the  entrance  of  fresh  air.  By  this 
means  siphonage  is  prevented,  for  when  the  various 
fixtures  discharge  contents  into  the  waste  or  soil  pipes 
air  is  sucked  in  from  the  opening  above  the  roof  to  re- 
place the  partial  vacuum  caused  by  the  descending  dis- 
charge of  water,  and  the  water  seals  in  the  several 
traps  are  not  disturbed. 


DISPOSAL  OF  WASTE        '  125 

The  various  lines  of  waste  and  soil  pipes  connect 
and  discharge  their  contents  into  the  house  drain  in 
the  cellar.  This  also  must  be  an  iron  pipe  and  is 
usually  six  inches  in  diameter  and  even  larger  when 
it  removes  the  waste  from  large  hotels,  apartments, 
factories,  etc.  The  house  drain  is  also  trapped  just  be- 
fore it  leaves  the  house  to  connect  with  the  street 
sewer,  thus  preventing  sewer  gases  from  entering  the 
house.  To  the  inner  side  of  this  trap  a  pipe  is  carried 
from  the  house  drain  to  the  outside  of  the  building 
to  admit  fresh  air  for  the  ventilation  of  the  various 
lines  of  waste  pipes  within  the  house.  In  modern 
plumbing  the  house  drain  is  exposed  in  order  that  de- 
fects may  be  promptly  discovered. 

The  old  method  of  placing  the  house  drain  under 
the  cellar  floor  or  constructing  it  of  brick  or  tile  is  a 
very  insanitary  one.  The  joints  of  brick  or  earthen- 
ware drains  cannot  be  properly  sealed,  and  may  be 
broken  easily  and  remain  undetected  for  some  time. 

Those  who  are  about  to  rent  houses  or  apartments 
should  inquire  very  carefully  concerning  the  character 
of  the  plumbing,  and  obtain  reasonable  evidence  that  it 
is  of  modern  construction  and  in  good  condition. 

The  water  carriage,  or  sewer,  system  of  built-up 
communities  is  usually  under  the  careful  observation 
of  municipal  authorities.  It  is  the  disposal  of  waste 
matter  in  the  country  and  small  towns,  where  no  sew- 
age system  exists  and  where  there  is  little  or  no  mu- 
nicipal inspection  or  protection  extended,  that  urgently 
calls  for  individual  attention. 

The  primitive  method  of  waste  disposal  commonly 


126  GOOD  HEALTH 

found  about  farms  or  country  homes  consists  of  a 
privy  vault  quite  close  to  the  house  for  the  deposit  of 
human  excrement,  the  slops  from  the  house  being" 
thrown  from  the  kitchen  door.  If  there  are  no  hogs 
or  fowls  about  the  place,  to  which  the  waste  matter 
from  the  kitchen  or  garbage  may  be  fed,  this  material 
may  sometimes  be  scattered  about  the  premises  to  be 
disposed  of  by  the  sun  and  air.  As  a  result,  very  in- 
sanitar}'  conditions  usually  exist,  for  the  waste  is 
largely  composed  of  organic  matter  which  quickly  de- 
composes and  becomes  offensive,  particularly  during" 
the  warm  weather.  Furthermore,  it  becomes  a  breed- 
ing place  for  flies  and  other  insects.  The  unpleasant 
odor  of  a  privy  vault  may  be  recognized  a  long  dis- 
tance away. 

The  structure  which  covers  the  privy  vault  is  usually 
most  simple  and  inexpensive ;  the  doors  do  not  close 
properly  and  the  windows  consist  of  openings  cut  in 
the  sides  of  the  building.  This  condition  permits  the 
free  entrance  and  exit  of  flies  and  other  insects,  and 
offers  little  relief  from  the  offensive  odors  within. 
The  danger  from  this  insanitary  situation  is  two- 
fold. Some  infectious  disease,  typhoid  fever  for 
instance,  may  affect  a  member  of  the  household,  not 
infrequently  in  an  unrecognized  form;  or  a  typhoid 
"carrier"  may  be  present.  The  infectious  germs  in  ty- 
phoid fever  are  located  in  the  intestinal  canal.  Dis- 
charges from  the  intestines  of  these  persons  are  depos- 
ited in  the  privy  vault  and  pass  through  the  defective 
walls  of  the  privy  vault  into  the  surrounding  soil.  They 
may  reach  some  nearby  water  supply,  and  in  this  way 


DISPOSAL  OF  WASTE  127 

transmit  the  disease.  Flies,  attracted  by  any  offensive 
matter,  are  always  found  in  and  about  the  privy  vault 
in  direct  contact  with  the  contents  of  the  vault,  and 
with  their  feet  covered  with  this  filth,  which  often  con- 
tains infectious  germs,  may  enter  the  house  and  con- 
taminate the  food  and  drink,  and  in  this  way  also 
spread  the  infection. 

The  privy  vault  found  in  the  country  generally  con- 
sists of  a  ground  excavation.  Sometimes  the  floor  and 
sides  of  this  vault  are  lined  with  brick  or  cement. 
Even  this  form  of  construction  is  insanitary,  since  the 
interior  lining  soon  becomes  defective  and  allows  the 
escape  of  filth  into  the  surrounding  soil.  Furthermore, 
it  is  practically  impossible  to  clean  or  deodorize  an  un- 
derground privy  vault.  As  a  matter  of  fact,  there 
is  not  the  slightest  justification  for  the  use  of  such  a 
device. 

If  no  other  method  of  disposing  of  human  excre- 
ment is  available,  the  privy  vault  used  should  be  an  all- 
metal  receptacle  placed  about  six  inches  above  the 
ground.  This  insures  an  air  space  around  and  about 
the  receptacle,  so  constructed  that  it  may  be  easily 
removed  by  hand  and  its  contents  emptied  and  buried 
at  a  point  where  there  is  reason  to  believe  there  is  no 
danger  of  infection.  The  receptacle  should  be  after- 
wards cleaned  and  freely  covered  with  lime  and  re- 
turned to  its  place.  A  wooden  receptacle  lined  with 
some  metallic  substance  is  not  even  as  desirable  as  a 
plain  wooden  one,  for  the  lining  soon  becomes  defec- 
tive or  broken  and  retains  organic  matter  which  other- 
wise might  be  removed. 


128  GOOD  HEALTH 

The  privy  house  and  vault  should  as  far  as  pos- 
sible be  made  inaccessible  to  flies  and  other  insects. 
The  doors  and  windows  of  the  privy  house  should  be 
kept  carefully  screened  with  wire  netting.  Ordinary 
mosquito  netting  and  other  textile  fabrics  are  practical- 
ly worthless  for  this  purpose,  for  they  cannot  be  se- 
curely attached  and  are  only  of  temporary  use. 

Contrary  to  the  general  belief,  it  is  impossible  prop- 
erly to  disinfect  the  contents  of  a  privy  vault  no  mat- 
ter what  agent  is  employed,  for  the  disinfectant  could 
not  be  sufficiently  incorporated  with  the  fecal  matter 
to  obtain  the  desired  results.  By  daily  covering  the 
mass  with  lime  it  may  to  a  certain  extent  be  deodorized. 

To  overcome  the  disadvantages  and  discomforts  of 
the  privy  vault,  particularly  at  night  time  and  during 
inclement  weather,  various  portable  apparatus  may  be 
purchased  for  indoor  service,  such  as  earth  closets. 
With  this  arrangement,  after  use  a  layer  of  earth  kept 
in  a  nearby  receptacle  is  thrown  over  the  fecal  matter. 
This  is  very  effective  in  preventing  an  unpleasant  odor 
particularly  if  the  bowl  or  pail  is  properly  emptied, 
cleaned  and  sprinkled  with  lime.  While  these  appli- 
ances are  comparatively  inexpensive  and  are  very  use- 
ful, they  do  not  represent  modern  sanitation. 

Stables  and  outhouses  are  usually  in  a  very  unclean 
condition,  and  manure  and  filth  are  thrown  about  in 
heaps  and  left  exposed  and  uncovered.  It  is  important 
to  remember  manure  is  a  very  common  breeding  place 
for  flies. 

Small  cesspools  are  often  dug  on  the  premises  for 
the  reception  of  fluid  waste  from  the  kitchen.    Usually 


DISPOSAL  OF  WASTE  129 

these  cesspools  consist  of  holes  dug  in  the  ground  into 
which  the  slops  are  emptied,  the  porosity  of  the  soil 
being  depended  upon  to  furnish  means  for  its  escape. 
Sometimes  the  cesspools  are  of  larger  size,  the  walls 
being  loosely  supported  with  bricks  and  stones. 

In  late  years  great  improvement  has  been  made  in 
the  disposal  of  house  waste  in  the  country.  In  the 
more  prosperous  homes  very  large  and  complicated 
cesspools  are  often  constructed  for  the  reception  of  all 
forms  of  waste  matter  from  the  premises,  including 
human  excrement,  thus  rendering  privy  vaults  un- 
necessary. It  is  a  very  excellent  substitute  for  the 
water  carriage  system  where  the  latter  is  not  available. 

It  has  been  shown  that  when  human  excrement  and 
other  forms  of  organic  matter  are  exposed  to  certain, 
bacteria  which  are  everywhere  present,  it  becomes  al- 
most entirely  disintegrated  and  changed  to  a  fluid 
consistence,  and  in  this  way  is  prepared  for  ground  ab- 
sorption. This  knowledge  has  been  made  use  of  by 
sanitary  engineers  in  arranging  for  waste  disposal  in 
the  following  manner : 

A  water-tight  receptacle,  known  as  a  septic  tank,  is; 
placed  below  the  ground  a  short  distance  from  the 
house.  This  may  consist  of  a  simple  cask  or  a  large 
and  somewhat  elaborate  cemented  receptacle.  Into  one 
side  of  this  receptacle  is  discharged  all  the  waste  mat- 
ter from  the  house  or  other  building,  including  human 
excrement,  and  here  the  action  of  the  bacteria  takes 
place,  and  the  dissolution- of  the  mass  occurs.  The  re- 
sulting fluid  flows  from  the  opposite  side  of  the  tank 
and  is  discharged  into  and  carried  away  by  an  under- 


130  GOOD  HEALTH 

ground  line  of  pipes.  The  joints  of  these  pipes  are 
slightly  separated,  so  that  the  fluids  passing  through 
may  gradually  escape  through  these  openings.  The 
pipes  are  known  as  "purifying"  tile  or  pipes,  and  are 
only  loosely  covered  with  pieces  of  stone  in  order  that 
the  escape  of  fluid  from  the  open  joints  may  not  be 
interfered  with  by  the  soil  which  covers  them.  This 
pipe  line  extends  underground  probably  not  more  than 
one  hundred  feet  from  the  building,  and  is  usually  so 
constructed  at  its  end  that  it  becomes  continuous  with 
two  or  more  smaller  pipes  pointing  in  different  direc- 
tions. Through  these  branches  the  fluid  waste  is  finally 
disposed  of.  It  must  be  remembered,  however,  that 
although  the  waste  has  been  broken  up  and  liquefied 
by  the  bacteria,  this  process  cannot  be  depended  upon 
to  destroy  all  the  infectious  germs  which  may  be  pres- 
ent in  the  discharged  matter.  Therefore,  the  pipe  line 
should  not  be  laid  in  the  immediate  vicinity  of  a  well. 
Where  this  system  is  installed,  it  is  required  that  there 
shall  be  a  supply  tank  for  the  purpose  of  flushing  the 
waterclosets  in  the  house.  The  details  of  this  are  re- 
ferred to  in  the  chapter  on  Water. 

The  manure  in  stables  should  be  kept  in  properly 
constructed  and  closed  receptacles  which  should  be 
frequently  emptied  and  cleaned.  The  latter  is  a  most 
important  consideration,  for  while  receptacles  are 
necessary  to  hold  manure  until  it  is  removed  for 
fertilizing  purposes,  the  vaults  or  boxes  in  which  it 
is  stored  are  not  often  kept  properly  closed,  and  do 
not  prevent  flies  from  entering  and  breeding.  A 
germicide  which  will  destroy  the  fly  larvae  without  in- 


DISPOSAL  OF  WASTE  131 

juring  the  bacteria  of  the  manure,  which  is  necessary 
to  convert  this  waste  into  plant  food,  was  long  sought 
for.  After  careful  experimental  work,  the  United 
States  Department  of  Agriculture  has  found  that 
powdered  hellebore  is  a  very  valuable  agent  for  this 
purpose.  One-half  pound  of  this  powder  to  ten  gal- 
lons of  water  is  sufficient  to  treat  eight  bushels  of  ma- 
nure. The  cost  of  this  would  be  about  six  cents. 
The  floors  of  stables  should  also  be  kept  clean  and 
lime  freely  applied.  There  is  no  more  effective  means 
of  rendering  the  interior  of  the  stables  and  outhouses 
odorless  than  by  the  frequent  use  of  whitewash. 

GARBAGE 

The  term  ''garbage"  generally  refers  to  the  animal 
and  vegetable  refuse  matter  from  the  kitchen.  This 
is  usually  mixed  with  house  waste,  such  as  paper, 
ashes,  etc.  In  cities  and  large  towns  garbage  is 
collected  at  certain  intervals  by  the  municipal  authori- 
ties and  disposed  of  either  by  burying,  by  incineration, 
or  by  the  process  known  as  reduction.  The  lat- 
ter refers  to  a  process  whereby  the  garbage  is  steril- 
ized by  steam  and  afterwards,  by  pressure  and  other 
means,  certain  products  are  extracted  which  are  sold 
for  various  commercial  purposes. 

From  a  sanitary  standpoint,  there  is  not  the  slight- 
est question  as  to  the  superiority  of  incineration  over 
all  other  methods  for  the  destruction  of  garbage. 
There  is  no  doubt  that  in  the  future  this  will  be 
the  common  practice.  Even  now  cheap  and  simple 
apparatus  may  be  purchased  for  household  use.    The 


132  GOOD  HEALTH 

incineration  of  waste  in  large  buildings  such  as  hos- 
pitals, has  been  in  successful  operation  for  a  number 
of  years  and  at  a  comparatively  small  expense.  Fur- 
thermore, this  method  of  refuse  disposal  is  now  being 
introduced  into  large  apartment  houses,  hotels  and  in- 
stitutions with  the  best  results. 

When  this  method  of  waste  destruction  has  pro- 
gressed sufficiently,  the  problem  of  disposing  of  mu- 
nicipal waste  will  be  largely  solved,  for  much  of  this 
work  will  be  done  within  doors  by  each  household. 

In  the  country  garbage  is  fed  to  hogs  and  fowls, 
sometimes  buried  and  often  thrown  over  the  ground  to 
be  disposed  of  by  natural  means.  Unfortunately,  the 
latter  is  a  slow  process  and  in  the  meantime  the  gar- 
bage decomposes,  becomes  offensive  and  furnishes  a 
breeding  place  for  flies  and  other  insects. 

House  owners  in  the  country  who  are  sufficiently 
progressive  and  can  afford  to  install  upon  the  premises 
a  septic  tank  for  the  disposal  of  human  excrement, 
and  other  house  waste,  should  also  consider  favorably 
the  purchase  of  a  small  and  comparatively  inexpensive 
incinerator  for  the  destruction  of  garbage. 


CHAPTER  VII 


VENTILATION 


Ventilation  relates  to  the  means  by  which  impure 
air  is  removed  from  a  building  and  fresh  air  is  intro- 
duced from  without  for  the  purpose  of  maintaining 
proper  respiration  and  comfort. 

In  the  consideration  of  ventilation,  it  must  be  borne 
in  mind  that  the  amount  of  fresh  air  required  in  an 
apartment  depends  chiefly  upon  the  number  and  con- 
dition of  its  inmates.  If  many  persons  are  present 
the  air  becomes  more  rapidly  polluted  than  when  only 
a  few  are  to  be  supplied. 

Furthermore,  the  amount  of  fresh  air  present  can- 
not always  be  determined  by  the  size  of  an  apart- 
ment, for  a  large  room  with  but  a  few  openings 
supplies  less  fresh  air  to  its  inmates  than  a  small  one 
into  which  fresh  air  has  free  access;  although  a  large 
room  is  capable  of  acting  as  a  reservoir  for  fresh  air, 
while  a  small  one  can  do  this  only  to  a  very  limited  ex- 
tent. 

Ventilation  has  chiefly  to  do  with  the  cold  months, 
for  during  the  warm  weather  when  windows  and 
doors  are  open,  a  sufficient  amount  of  fresh  air  is  ad- 
mitted without  resort  to  various  devices  for  this  pur- 
pose.   Ventilation  may  be  classified  as  natural  and  arti- 

133 


134  GOOD  HEALTH 

iicial.  It  is  chiefly  the  former  which  will  be  discussed 
in  this  chapter,  for  artificial  ventilation,  particularly 
that  which  is  complicated  and  on  a  large  scale,  is 
rather  within  the  province  of  the  architect. 

Nature  plays  a  very  important  part  in  ventilation. 
Owing  to  the  laws  of  diffusion  of  gases  and  the 
great  pressure,  of  the  atmosphere,  which  has  al- 
ready been  discussed,  it  is  practically  impossible  to 
prevent  air  from  entering  the  interior.  It  will  go 
through  any  opening,  no  matter  how  small;  it  will 
even  penetrate  brick  and  mortar.  This,  however,  does 
not  provide  adequately  for  ventilation,  and  when  doors 
and  windows  are  closed,  it  devolves  upon  us  to  ar- 
range for  a  more  generous  supply  for  proper  respira- 
tion. 

To  secure  good  ventilation,  dwelHng  houses  and 
apartments  should  as  far  as  possible  be  located  where 
there  is  plenty  of  fresh  air,  away  from  narrow  streets, 
high  buildings  and  offensive  trades.  Residence  in  sub- 
urban towns  should  be  encouraged,  even  if  it  ex- 
acts time  and  the  discomforts  of  travel,  for  the  purer 
air  in  these  sections  will  bring  better  health  and 
longer  life.  It  is  particularly  necessary  to  children, 
who,  like  plants,  must  have  fresh  air  and  sunshine  to 
thrive. 

There  should  be  free  ventilation  in  schools  and 
workshops,  particularly  where  employees  perform 
manual  labor,  as  the  exhalations  from  the  skin  and 
the  mucous  membrane  under  these  conditions  are  gen- 
erally increased,  are  more  rapidly  thrown  off,  and 
more  quickly  contaminate  the  air  than  where  but  lit- 


VENTILATION  135 

tie  physical  exertion  is  required.  Besides,  when  there 
is  great  physical  activity,  more  oxygen  is  needed  for 
respiration. 

In  country  houses  and  private  city  dwellings  and 
in  properly  situated  and  arranged  apartment  houses, 
the  question  of  ventilation  is  not  particularly  disturb- 
ing nor  is  it  true  that  temporary  exposure  to  the  air 
in  theaters,  halls,  subways  or  public  conveyances  is  in- 
jurious to  health.  Even  though  the  air  is  more  or  less 
impure,  it  is  tolerated  for  a  reasonable  period,  and  is 
not  prejudicial  to  our  well-being,  except  possibly  to 
those  who  are  more  or  less  constantly  subjected  to 
these  conditions. 

The  unpleasant  or  serious  effects  of  polluted  air 
are  more  common  to  those  who  live  in  tenement 
houses  in  closely  built-up  sections  and  in  residences 
close  to  factories  where  the  air  is  contaminated  by 
gases  and  other  unhealthful  products  and  to  those  who 
work  underground  or  in  improperly  constructed  or 
ventilated  workshops  and  factories.  Long  exposure 
to  these  conditions  is  likely  to  render  the  system  more 
susceptible  to  disease.  It  is  important  that  those  who 
are  obliged  to  live  in  these  unfavorable  surround- 
ings should  be  taught  that  the  best  means  of  overcom- 
ing their  bad  influence  is  to  remain  outside  in  the  fresh 
air  whenever  it  is  possible.  We  may  learn  much  from 
the  animals  in  this  direction,  as  their  freedom  from 
disease  is  largely  due  to  the  fact  that  they  are  more 
or  less  constantly  in  the  open  air. 

Air  when  warmed  becomes  lighter,  expands  and 
ascends ;  therefore,  theoretically  at  least,  it  will  escape 


136  GOOD  HEALTH 

more  quickly  to  a  higher  level.  For  this  reason  exits 
for  house  air  are  generally  arranged  in  the  ceiling  or 
upper  part  of  the  room  through  openings  which  dis- 
charge into  the  air  outside.  Cold  air  is  heavier  and 
more  condensed,  and  enters  more  freely  a  lower  level. 
However,  in  ventilating  a  house,  the  inlet  for  air 
should  not  be  too  close  to  the  floor,  for  it  is  then 
quite  sure  to  cause  drafts.  Also,  if  the  inlet  is  too 
near  the  ground,  the  air  may  be  contaminated  with 
offensive  odors  from  decomposed  organic  matter 
which  is  often  found  on  the  surface. 

In  arranging  for  ventilation,  incoming  currents  of 
air  should  be  made  to  enter  about  four  or  five  feet 
above  the  floor  and  be  given  an  upward  turn.  In 
this  way  it  not  only  more  effectively  purifies  the  room 
and  aids  in  expelling  the  foul  air,  but  what  is  par- 
ticularly important,  it  largely  overcomes  the  unpleas- 
ant effects  of  direct  currents  of  air  upon  the  body. 
Direct  drafts  should  be  avoided,  for  they  are  liable 
to  promote  colds,  probably  by  rendering  more  active 
the  bacteria  on  the  surface  of  the  mucous  membrane 
of  the  respiratory  tract.  Not  infrequently  a  cold 
leads  to  more  serious  affections. 

If  the  arrangements  are  such  that  incoming  air  en- 
ters the  room  in  a  direct  current  from  an  open  win- 
dow, its  force  may  be  very  much  diminished  by  the 
use  of  fabrics  not  too  closely  woven,  such  as  cheese- 
cloth or  the  finest  wire  netting,  placed  over  the  intake. 
The  former  material  is  very  cheap  and  may  be  pur- 
chased anywhere.  A  piece  of  it  stretched  over  a  home- 
made frame  fitted  into  a  space  made  by  raising  the 


VENTILATION  137 

window,  constitutes  a  very  simple,  effective  and  in- 
expensive means  of  ventilating  an  apartment  without 
causing  a  draft.  It  also  sifts  out  certain  impurities 
in  the  air.  For  this  reason,  the  cheesecloth  should 
be  washed  occasionally  or  renewed.  Notwithstanding 
statements  to  the  contrary,  drafts  should  be  avoided. 
They  may  not  directly  cause  colds,  influenza,  sore 
throats  and  the  like,  but  they  constitute  a  formidable 
exciting  cause.  Persons  in  good  health  with  a  splen- 
did resisting  power  may  not  be  susceptible  to  these 
conditions  or  only  slightly  so.  Unfortunately,  a  large 
percentage  of  the  public  is  not  thus  happily  protected, 
therefore,  ventilation  has  to  be  adapted  to  meet  aver- 
age requirements.  The  lesson  we  may  gain  from  this, 
however,  relates  to  the  inestimable  value  of  maintain- 
ing good  health,  and  thus  offering  a  powerful  resist- 
ance to  disease. 

Everyone  should  be  interested  in  home  ventilation, 
and  should  learn  to  improvise  some  simple  and  inex- 
pensive method  for  this  purpose,  not  alone  for  the 
sake  of  economy,  but  also  as  a  matter  of  education. 
There  are  many  simple  and  practical  devices  for  ven- 
tilation which  may  be  purchased  for  a  small  sum, 
conforming  to  the  above  principles.  For  instance,  a 
wooden  panel  may  be  constructed  about  eight  inches 
wide,  placed  crosswise  at  the  bottom  of  the  window 
and  made  to  slant  a  little  toward  the  interior.  The 
lower  sash  should  be  then  raised  to  a  point  helozv  the 
upper  border  of  the  panel.  The  air  entering  at  this 
opening  is  directed  upwards  and  is  much  less  liable 
to  produce  drafts.     Another  very  good  method  con- 


138  GOOD  HEALTH 

sists  in  raising  the  lower  sash  a  certain  distance  and 
filling  the  opening  made  at  the  bottom  of  the  window 
with  a  close  fitting  panel  of  wood  or  other  material. 
The  separation  which  then  occurs  between  the  lower 
end  of  the  upper  sash  and  the  upper  end  of  the  lower 
sash,  still  allows  a  good  free  inlet  for  the  air.  By 
this  arrangement,  also,  the  current  will  be  directed 
upwards. 

These  simple  principles  in  a  more  complicated  and 
extended  form  are  applied  by  engineers  in  planning 
for  the  ventilation  of  great  buildings  and  large  dwelling 
houses.  Modern  methods  of  artificial  ventilation  are 
now  so  perfected  that  one  is  not  conscious  of  the  con- 
stant withdrawal  of  impure  air  and  supplying  of  fresh 
air. 

In  discussing  the  subject  of  ventilation,  great  stress 
has  been  laid  upon  the  importance  of  the  fireplace 
as  a  means  of  withdrawing  vitiated  air  from  an  apart- 
ment. It  is  true  that  a  draft  does  occur  upwards 
through  the  chimney  connected  with  the  grate  by  the 
current  of  the  air  outside,  and  that  this  suction  force 
does  act  as  an  outlet  for  inside  air ;  but  fresh  air  just 
entering  an  apartment  may  also  be  removed  in  this 
way.  Moreover,  adverse  winds  may  force  a  current 
of  air  down  the  chimney.  It  is  sufficient  to  know  that 
the  use  of  grate  fires  is  not  a  modern  means  of  ven- 
tilating a  building;  besides,  grates  are  not  generally 
distributed  throughout  the  house. 

It  has  been  reckoned  by  sanitarians  that  under  or- 
dinary conditions  three  thousand  cubic  feet  of  air 
each  hour  for  every  person  present  should  be  admit- 


VENTILATION  139 

ted  to  a  living  apartment;  even  more  than  this  if  ac- 
tive exercise  is  performed.  During  this  time  means 
must  also  be  employed  to  remove  the  vitiated  air. 
It  is  further  estimated  that  each  person  within  doors 
should  be  allowed  from  three  to  twelve  hundred  cubic 
feet  of  air  space.  Municipal  regulations  require  that 
lodging  houses  shall  supply  about  five  hundred  cubic 
feet  of  space  for  each  lodger;  this  would  mean  an 
apartment  about  seven  feet  square  and  ten  feet  high. 
A  much  larger  amount  is  called  for  in  hospitals.  The 
fact  is  often  lost  sight  of  in  preparing  municipal  reg- 
ulations for  the  ventilation  of  lodging  houses  and 
other  institutions  where  a  large  number  of  persons 
are  brought  together,  that  notwithstanding  the  cubic 
space  permitted  for  each  lodger  is  specified,  careful  at- 
tention is  not  always  given  to  the  operation  of  the 
various  devices  installed  for  the  purpose  of  ventila- 
tion. 

It  may  be  said  that  the  calculations  referred  to  were 
made  largely  upon  the  assumption  that  the  compo- 
sition of  the  air  within  a  building  undergoes  consid- 
erable change,  particularly  when  many  persons  are 
present,  and  that  an  increase  in  the  amount  of  carbon 
dioxid  takes  place,  which  is  responsible  for  the  uncom- 
fortable sensation  which  occurs  in  an  improperly  ven- 
tilated apartment.  More  recent  investigation  has 
shown  that  the  composition  of  the  air  does  not  under- 
go any  considerable  change  under  the  circumstances 
referred  to,  and  that  an  increase  in  the  amount  of  car- 
bon dioxid  within  reasonable  limits  is  not  detrimental 
to    health.      Furthermore,    experimental    work    has 


140  GOOD  HEALTH 

proved  that  the  headache,  nausea,  drowsiness,  etc., 
which  so  commonly  affect  us  in  badly  ventilated  rooms 
are  due  largely  to  emanations  from  the  lungs  and  skin 
and  from  decayed  teeth  of  those  present  who  are  care- 
less about  personal  cleanliness.  In  addition  to  this, 
recent  experiments  have  shown  that  these  unpleasant 
conditions  are  more  pronounced  when  a  high  temper- 
ature and  moisture  are  present  in  an  apartment;  fur- 
thermore, if  the  temperature  of  the  room  is  low,  with 
the  small  amount  of  moisture  which  is  necessary  for 
comfort  and  proper  respiration,  even  when  contami- 
nation of  the  air  is  quite  pronounced,  unpleasant  ef- 
fects are  not  usually  noticeable.  This  goes  far  to 
prove  that  it  is  not  so  much  the  change  in  the  compo- 
sition of  air  within  an  apartment,  as  the  products  of 
decomposition  given  off  from  the  bodies  of  those  pres- 
ent, a  high  temperature  and  increased  moisture  which 
render  an  interior  unpleasant  to  its  inmates.  It  is 
generally  accepted  that  a  temperature  of  70°  F.  fur- 
nishes comfort  and  comparative  freedom  from  de- 
pressing conditions. 

The  air  of  the  interior  can  never  be  made  as  re- 
freshing and  exhilarating  as  the  open  air.  The  lesson 
we  should  learn  from  this  is  that  while  every  effort 
should  be  made  to  keep  the  house  well  ventilated,  it 
is  important  that  a  large  part  of  our  time  should  be 
spent  out  of  doors. 


CHAPTER  VIII 


HEATING   AND   LIGHTING 


HEATING 

Artificial  heating  as  it  applies  to  the  interior  of 
buildings  includes  the  use  of  fireplaces,  gas,  oil  or 
coal  stoves,  hot-air,  hot-water  or  steam  apparatus  and 
electricity. 

Little  can  be  said  in  favor  of  coal  or  v^ood  open 
fireplaces  aside  from  their  cheerful  appearance  and 
the  sentiment  associated  with  them.  The  pleasing 
effect  of  grate  fires  is  to  a  large  extent  now  supplied 
by  gas  logs  which  emit  no  smoke  or  sparks,  and  can 
be  promptly  shut  off  when  heat  is  no  longer  required. 
Grate  fires  are  inferior  for  heating  purposes  and  are 
very  extravagant.  When  coal  is  used,  only  about 
twelve  or  fourteen  per  cent  of  the  heat  generated  is 
of  practical  value,  and  much  less  where  wood  is 
burned.  An  apartment  is  but  imperfectly  heated  by 
grates,  whether  the  fuel  is  wood,  coal  or  gas,  for  por- 
tions of  the  room  some  distance  from  the  fireplace 
remain  at  a  much  lower  temperature  than  those  in  the 
immediate  vicinity,  the  temperature  diminishing  as  the 
distance  from  the  grate  increases. 

A  coal  stove  cannot  be  regarded  as  a  sanitary  mod- 

141 


142  GOOD  HEALTH 

ern  means  of  heating.  The  warmth  is  not  evenly  dis- 
tributed throughout  the  apartment,  and  when  the  stove 
is  properly  heated,  the  necessary  moisture  in  the  air 
is  very  much  decreased,  and  the  apartment  is  uncom- 
fortably dry.  Besides,  particles  of  organic  matter 
floating  about  the  room  become  charred  and  offensive. 

The  danger  attributed  to  a  coal  stove  is  not  imagi- 
nary. The  combustion  of  coal  forms  poisonous  gases 
which  frequently  escape  into  the  apartment,  particu- 
larly when  fresh  coal  is  added.  When  stoves  are 
used,  the  danger  from  this  source  should  be  carefully 
guarded  against  by  having  the  chimney  or  stovepipe 
damper  fully  opened  in  order  that  the  gases  may 
quickly  escape.  It  is  not  an  uncommon  practice  to 
leave  the  stove  door  open  and  to  close  the  damper 
partly  or  almost  entirely  to  reduce  the  heat.  This 
should  not  be  done,  and  to  prevent  it  the  damper  in 
the  stovepipe  or  chimney  should  be  so  constructed 
that  it  cannot  be  entirely  closed.  Moisture  to  over- 
come the  dryness  caused  by  this  means  of  heating 
may  be  supplied  by  placing  a  good-sized  receptacle 
containing  water  on  the  back  of  the  stove  or  in  its  im- 
mediate vicinity. 

While  gas  and  oil  present  about  the  same  objec- 
tions for  heating  as  they  do  for  illuminating  purposes 
— that  is,  unhealthful  products  of  combustion  and  the 
larger  consumption  of  oxygen — it  must  be  admitted 
that  heating  appliances  or  stoves  using  these  agents 
for  fuel  have  within  recent  years  been  so  far  improved 
that  with  care  they  may  be  employed  without  injuri- 
ous effects.     They   are    better   and   safer  than   coal 


HEATING  AND  LIGHTING  143 

stoves,  freer  from  dirt,  and  they  may  be  shut  off  at 
any  moment,  a  very  important  factor  from  an  eco- 
nomical standpoint. 

Hot-water  and  steam  pipes  constitute  very  satisfac- 
tory and  sanitary  means  of  obtaining  heat.  The 
warmth  they  supply  is  more  evenly  distributed  and 
the  moisture  in  the  apartment  is  far  less  affected 
than  when  stoves  are  used.  They  consume  no  oxygen, 
and  give  off  no  product  of  combustion  to  vitiate  the 
air. 

Although  from  a  sanitary  standpoint  hot-air  fur- 
naces are  inferior  to  steam  and  hot  water  for  heating 
purposes,  it  is  not  unhealthful  if  the  furnace  is  prop- 
erly cared  for;  and  if  the  fresh  air  and  moisture  are 
constantly  supplied  for  its  operation. 

While  at  present  the  use  of  electricity  for  heating 
purposes  is  largely  prohibitive  on  account  of  its  cost, 
it  constitutes  the  most  healthful  and  desirable  means 
of  obtaining  warmth  for  the  interior,  and  will  some 
day  be  available  for  general  use. 

The  proper  temperature  of  an  interior,  when  it  can 
be  regulated,  depends  upon  the  character  of  the  place 
and  its  inmates.  In  a  workshop  where  employees  are 
engaged  in  manual  labor,  the  temperature  required  is 
much  below  that  needed  in  an  apartment  where  per- 
sons are  performing  little  or  no  physical  exercise. 
Within  the  house  or  office,  a  comfortable  tempera- 
ture is  70°  to  75°  F.  Small  children  and  old  people 
require  a  somewhat  higher  temperature  than  oth- 
ers, and  the  temperature  required  during  the  night 
is  less  than  during  the  day,  provided  a  person  is  well 


144  GOOD  HEALTH 

wrapped  up  in  bed.    This  part  of  the  subject  will  again 
be  referred  to. 

LIGHTING 

The  various  means  of  obtaining  artificial  light  in- 
volves the  use  of  candles,  oil  lamps,  gas  and  electricity. 
For  practical  use  candles  are  now  employed  only 
where  other  means  of  lighting  are  not  available  and 
for  decorative  purposes.  Even  in  the  most  remote 
parts  of  the  world,  candles  have  been  largely  replaced 
by  lamps  burning  derivatives  of  petroleum  oil.  The 
latter  method  of  lighting  is  too  well  known  to  call 
for  any  special  description.  Oil  gives  a  soft  and  sat- 
isfactory light,  and  is  very  pleasing  to  the  eyes.  The 
objection  to  its  use,  particularly  in  an  apartment  or 
public  place,  consists  in  the  large  number  of  burners 
required  which  call  for  special  care  and  watching,  for 
negligence  in  this  direction  may  lead  to  explosions  or 
fire,  and  also  in  the  fact  that  combustion  aids  in  vitiat- 
ing the  air  and  generates  an  unpleasant  degree  of 
heat.  The  reservoirs  of  lamps  should  be  constructed 
of  metal,  and  not  of  glass  or  china,  which  is  liable  to 
crack  or  break.  They  should  have  a  broad  base  for 
safety.  A  reservoir  should  not  be  filled  up  to  the  top 
nor  should  the  oil  be  allowed  to  burn  low,  for  when 
the  oil  in  the  reservoir  is  reduced  in  amount,  there 
is  sufficient  room  for  gases  to  form,  which  may  be  ig- 
nited by  the  flame  through  defective  wicks  at  wick 
openings  or  by  blowing  down  a  chimney,  with  a  possi- 
ble resulting  explosion. 

A  wick  should  be  soft,  should  fit  perfectly  to  the 


HEATING  AND  LIGHTING  145; 

wick  tube  and  should  be  frequently  removed  and  a 
new  one  substituted,  in  order  that  a  proper  length  may 
be  maintained.  When  lighted,  the  wick  should  at  first 
be  turned  down  and  then  slowly  raised.  A  lamp 
should  not  be  blown  out;  this  is  not  necessary  if  it  is 
properly  supplied  with  an  extinguisher.  If  the  lat- 
ter is  not  present,  the  wick  should  be  carefully  turned 
down  until  there  is  only  a  small  flame,  and  a  cover- 
ing or  cap  placed  on  top  of  the  lamp  chimney  which 
will  prevent  the  entrance  of  air  necessary  for  com- 
bustion. It  is  a  dangerous  practice  to  move  lighted 
lamps  about.  It  may  be  properly  said  that  the  best 
way  to  prevent  danger  from  oil  lamps  is  to  purchase 
a  first-class  modern  apparatus,  instead  of  a  cheap  one. 
which  is  inefficient  and  dangerous. 

The  artificial  lights  most  generally  used  at  the  pres- 
ent time  are  furnished  by  coal,  gas  and  electricity. 
While  gas  has  many  advantages  over  oil  as  an  illumi- 
nant  it  is  not  without  its  faults  and  dangers.  Like- 
candles  and  lamps,  it  gives  off  various  products  of 
combustion  and  consumes  a  large  amount  of  the  oxy- 
gen of  the  air,  each  burner  probably  requiring  more 
than  an  adult  human  being.  The  danger  resulting 
from  the  use  of  gas  for  artificial  lighting  is  usually 
due  to  carelessness.  If  gas  is  not  properly  turned 
off,  the  air  in  the  apartment  is  rendered  unfit  for- 
respiration  and  explosions  may  occur.  As  far  as 
the  selection  of  proper  apparatus  and  burners  is 
concerned,  this  may  be  safely  left  in  the  hands  of 
first-class  dealers  in  fixtures ;  there  is  no  economy  in 
purchasing  cheap  or  imperfect  illuminating  apparatus.. 


146  GOOD  HEALTH 

Electric  light  constitutes  the  most  sanitary,  effective 
and  practical  illuminating '  agent  which  can  be  em- 
ployed. It  absorbs  no  oxygen  from  the  air,  gives  gff 
but  little  heat  and  is  devoid  of  danger  except  that 
which  may  occur  as  the  result  of  improper  wiring  or 
insulation.  From  a  sanitary  standpoint,  it  would  be 
difficult  to  overestimate  the  value  of  electricity  for 
lighting  purposes.  Before  it  was  generally  employed 
for  this  purpose,  it  was  exceedingly  difficult  to  ven- 
tilate theaters  or  other  buildings  where  many  were 
congregated  and  where  gas  and  oil  were  used  in 
large  quantities  for  lighting  purposes. 


CHAPTER  IX 


PERSONAL   HYGIENE 


Personal  hygiene  has  to  do  with  the  means  by 
which  our  individual  health  is  preserved,  chiefly 
through  the  proper  maintenance  of  the  resisting  power 
of  the  body.  The  value  of  the  latter  cannot  be  over- 
estimated, for  upon  it  largely  depends  the  prevention 
of  disease.  It  is  important  to  bear  in  mind  that  proper 
care  of  the  body  does  not  mean  that  we  shall  be  de- 
prived of  the  pleasure  of  life  but  only  that  we  shall 
maintain  in  good  condition  the  wonderful  machine 
which  is  placed  in  our  keeping.  This  is  all  that  nature 
exacts  from  us.  Essential  factors  concerned  in  per- 
sonal hygiene  are :  proper  food  and  drink,  exercise, 
cleanliness  of  the  body,  sleep,  appropriate  clothing,  and 
temperance  in  all  things;  the  last  being  a  most  neces- 
sary consideration. 

FOOD  AND  DRINK 

The  importance  of  guarding  carefully  the  digestive 
and  alimentary  tract  against  improper  food  and  espe- 
cially overeating,  has  been  referred  to  in  the  chap- 
ter on  Food.  A  mixed  diet  composed  of  plain,  simple 
and  easily  digested  substances  constitutes  the  proper 
and  natural  means  of  securing  nourishment,  and  leaves 

147 


148  GOOD  HEALTH 

unimpaired  the  various  organs  concerned  in  this  im- 
portant function.  The  necessity  for  food  of  this  char- 
acter and  the  ease  with  which  its  digestion  is  normally 
accomplished  have  already  been  discussed.  Advanced 
civilization  has  to  a  great  extent  destroyed  the  desire 
for  simple  food,  and  has  substituted  a  taste  for  rich 
and  indigestible  dishes  which  is  dearly  paid  for  in 
more  ways  than  one. 

Probably  nothing  contributes  more  to  the  unpleasant 
and  serious  disturbances  of  the  digestive  tract  than  a 
frequent  indulgence  in  formal  and  public  dinners,  for 
at  these  functions  hosts  and  hostesses  vie  with  one  an- 
other in  placing  before  their  guests  food  and  drink  in 
great  variety  and  in  most  tempting  and  indigestible 
forms.  If  reformation  in  this  direction  could  be  ac- 
complished, and  if  instead  of  this  display  a  few  well 
•cooked  and  nourishing  articles  could  be  presented,  and 
the  entertainment  depend  upon  the  social  element 
rather  than  food,  it  would  furnish  an  example,  the 
value  of  which,  as  far  as  correcting  errors  of  diet  goes, 
would  be  difficult  to  overestimate. 

It  is  not  intended  in  this  book  to  discuss  in  detail  al- 
coholic drinks  and  the  unpleasant  and  dangerous  re- 
sults which  follow  their  use.  Addiction  to  the  use  of 
alcoholic  drinks  weakens  the  resisting  power  of  the 
body  which  is  essential  to  the  preservation  of  health. 
The  ability  of  the  organism  to  counteract  the  in- 
jurious effects  of  alcohol  is  gradually  worn  down  and 
the  poisoning  process  makes  such  inroads  as  to  render 
ineffective  the  wonderful  protective  mechanism  of  the 
body.     This   fact  is  well  established.     Liquor-drink- 


PERSONAL  HYGIENE  149. 

ing  is  largely  a  matter  of  habit  without  reasonable 
justification.  Besides,  it  is  associated  so  often  with 
unpleasant  public  demonstrations  that  it  has  become 
familiar  to  all  and  consequently  has  overshadowed  the 
dangers  of  intemperance  in  other  directions.  The 
public  does  not  appreciate  this,  for  many  of  those  who. 
regard  with  horror  the  use  of  alcohol  are  gluttons 
at  the  table  and  often  die  from  causes  superinduced 
by  overeating. 

Coffee  and  tea  are  delicious  beverages  and  are  used 
throughout  the  world,  and  there  is  no  good  reason  tO' 
believe  that  when  taken  by  healthy  adults  in  a  moder- 
ate  amount  any  well  defined  unpleasant  results  will 
follow.  However,  when  intemperately  used,  the  ner- 
vous system  is  often  seriously  involved. 

In  late  years,  tea  drinking  has  been  introduced  inta 
this  country  as  a  social  institution  and,  like  all  fads,  is 
being  overdone.  A  serious  factor  in  connection  with 
the  tea  and  coffee  habit  is  their  increasing  use  among 
children  who  drink  them  daily  and  depend  upon  them 
for  their  stimulating  effects.  Children  pass  through  a. 
formative  stage  during  which  the  various  tissues  of 
the  body  develop  and  reach  their  growth.  As  above 
stated,  coffee  and  tea,  as  well  as  tobacco  and  alcohol, 
seriously  affect  the  nervous  system,  particularly  of 
young  children,  and  there  is  no  doubt  that  in  persons 
of  this  age  these  agents  are  not  only  responsible  for 
temporary  injury  but  lay  the  foundation  for  more 
serious  affections.  Parents  are  largely  responsible  for 
the  tea  and  coffee  habit  among  children,  for  it  is 
usually  contracted  at  home. 


150  GOOD  HEALTH 

EXERCISE 

Exercise  is  necessary  for  many  reasons :  It  aids 
digestion,  assists  in  securing  proper  sleep  and  helps  to 
maintain  the  various  functions  of  the  body.  Without 
it  the  lungs  are  not  properly  inflated  and,  when  this  is 
the  case,  are  far  less  able  to  resist  the  attack  of  cer- 
tain diseases  which  commonly  affect  these  organs — 
tuberculosis,  for  instance.  Besides,  if  muscles  are  not 
properly  exercised,  they  are  apt  to  become  reduced  in 
size  and  importance,  for  nature  does  not  look  indul- 
gently upon  the  support  of  tissues  which  perform  little 
or  no  work. 

The  most  important  function  of  exercise,  the  adjust- 
ment of  the  circulation,  is  not  generally  understood. 
This  is  brought  about  largely  by  the  activity  of  the 
great  muscular  system  which  goes  far  to  relieve  con- 
gested centers,  such  as  the  brain,  liver  and  other  or- 
gans. For  this  reason,  exercise  is  particularly  val- 
uable for  the  so-called  brain  workers  who  during  the 
day  and  very  often  at  night  are  engaged  in  work 
which  calls  for  undue  activity  on  the  part  of  the  brain. 
To  provide  for  this,  an  increased  supply  of  blood  is 
required.  If  this  pressure  continues  too  long  the 
small  blood-vessels  of  the  brain  become  dilated  and 
stretched,  and  are  very  apt  to  undergo  degenerative 
changes.  Later  in  life  this  condition  leads  to  serious 
results,  the  commonest  of  which  is  hemorrhage  of  the 
brain,  or  apoplexy. 

Proper  exercise  relieves  this  overcharged  condition 
of  the  brain  by  drawing  a  large  amount  of  blood  to 
the  surface  of  the  body.    Other  congested  organs,  par- 


PERSONAL  HYGIENE  151 

ticularly  those  of  the  digestive  tract — the  liver,  for 
instance — are  similarly  relieved  by  exercise;  and  it 
may  be  said  that  upon  this  simple  means  of  adjusting- 
the  circulation  largely  depends  the  preservation  of 
health  and  the  prolongation  of  life. 

Walking  is  the  natural  and  by  far  the  most  valuable 
form  of  exercise.  It  is  available  for  persons  of  any 
age  and  any  class ;  it  costs  nothing  and  requires  practi- 
cally no  equipment.  While  horseback  riding  is  very 
pleasant  and  exhilarating  and  other  forms  of  exercise,, 
such  as  gymnasium  work,  tennis  and  rowing,  are  of 
value  in  their  way,  they  are  far  inferior  to  walking 
as  far  as  the  adjustment  of  the  circulation  is 
concerned. 

Comparatively  few  who  reside  in  cities  can  afford 
the  luxury  of  horseback  riding.  It  requires  consid- 
erable preparation,  and  even  among  those  who  need 
not  consider  the  expense  involved,  this  form  of  exer- 
cise is  usually  indulged  in  only  at  irregular  intervals. 
There  are  men  and  women  who  in  advanced  life  se- 
lect horseback  riding  as  a  means  of  overcoming  cor- 
pulence and  other  unpleasant  conditions  commonly  due 
to  sedentary  habits  or  overindulgence  at  the  table. 
Many  of  these  persons  have  organic  or  other  affections 
of  the  pelvic  content  or  other  physical  impairments 
which  should  contraindicate  horseback  riding.  It  is 
important  also  to  mention  that  these  persons  are  often 
very  careless  about  using  a  proper  support  for  the  ab- 
dominal walls,  particularly  during  exercise — a  very 
important  consideration.  Furthermore,  persons  of 
advanced  age   should  not  take   regular  active   exer- 


152  GOOD  HEALTH 

cise  of  any  kind  without  the  approval  of  a  physician. 

The  gymnasium  has  its  value  for  athletes  and  for 
those  v^ho  desire  to  develop  the  muscular  system,  but 
it  is  indoor  exercise  and  is  hence  robbed  of  half  its 
value.  This  form  of  exercise  requires  apparatus  and 
is  not  adapted  for  the  general  public;  besides,  it  is 
■more  or  less  violent  and  appropriate  only  for  those 
who  are  comparatively  young.  This  statement  in  a 
general  way  applies  to  the  innumerable  exercising  ap- 
paratus manufactured  for  home  use,  the  value  of 
which  is  limited,  that  is,  for  the  use  of  those  who  are 
unable  to  secure  the  benefits  of  outdoor  exercise. 

Rowing  and  tennis  are  healthful  forms  of  outdoor 
^exercise,  but  are  available  at  only  certain  seasons  of 
the  year ;  besides,  they  are  not  suitable  for  all  ages. 

The  game  of  golf,  which  has  become  very  popular 
in  this  country,  is  practically  walking  made  pleasant 
and  interesting,  and  no  other  kind  of  exercise  ever 
practised  has  contributed  so  much  to  the  repair  of 
health,  particularly  in  persons  with  overtaxed  brains 
and  sluggish  digestive  apparatus.  It  is  suitable  for 
persons  of  any  age  but  unfortunately  it  is  not  within 
the  reach  of  all. 

A  careful  analysis  of  the  subject  of  exercise  will 
prove  that  it  is  regular,  and  not  occasional,  exercise 
Ts^hich  is  required  to  maintain  health,  and  there  is  no 
form  which  equals  a  daily  walk  in  the  open  air.  If 
time  cannot  be  found  for  exercise  during  the  day  it 
should  be  taken  after  sundown,  for  there  is  no  truth 
in  the  belief  that  night  air  is  unhealthful,  although 
it  may  not  give  the  fulLvalue  and  stimulating  effect 


PERSONAL  HYGIENE  153 

of  exercise  taken  during  the  daytime.  It  was  formerly 
believed  that  night  air  bred  malaria;  now  we  know 
that  this  disease  is  transmitted  from  one  person  to 
another  only  by  a  variety  of  the  mosquito  known  as 
the  Anopheles. 

The  benefit  obtained  from  walking  is  substantial  in 
proportion  to  the  regularity  with  which  it  is  per- 
formed ;  from  four  to  six  miles  may  be  regarded  as  an 
average  daily  walk  for  an  adult,  and  the  result  is  far 
more  effective  when  the  entire  distance  is  covered  at 
one  time.  A  good  pace  should  be  taken,  although  it  is 
not  advisable  that  one  walk  too  fast.  The  shoulders 
should  be  erect  in  order  that  proper  respiration  may  be 
sustained;  in  this  way  the  lungs  are  well  inflated  and 
ventilated. 

A  short  walk  is  not  of  much  value  in  relieving  the 
congestion  of  internal  organs,  for  the  exercise  ends 
before  a  sufficient  amount  of  blood  is  withdrawn  from 
these  centers;  neither  is  a  long  walk  in  piecemeal  as 
apt  to  secure  the  desired  result  as  a  long  walk  without 
interruption. 

For  the  first  mile  or  so  of  the  walk  a  person  in  need 
of  exercise  is  not  conscious  of  any  appreciable  change, 
but  if  the  walk  is  continued  mental  weariness  is  quite 
apt  to  disappear  and  is  succeeded  by  a  feeling  of  well- 
being  as  the  blood  is  brought  ''below  the  belt" — a  term 
which  may  be  used  to  indicate  that  the  circulation  has 
been  largely  diverted  from  the  internal  organs,  partic- 
ularly the  brain,  which  is  now  passing  to  a  period  of 
rest. 

It  is  not  good  to  take  a  long  brisk  walk  directly  after 


154  GOOD  HEALTH 

a  full  meal  because  an  increased  quantity  of  blood  is 
then  needed  for  digestion,  and  too  much  exercise  may 
interfere  with  this  important  function,  A  little  exer- 
cise, however,  at  such  a  time  is  not  harmful. 

Persons  under  a  prolonged  mental  strain  commonly 
experience  a  sense  of  fatigue.  This  is  as  a  rule  a 
mental  and  not  a  physical  condition,  and  the  proper 
remedy  for  it  is  exercise  in  the  open  air  and  not  rest. 
Too  much  importance  cannot  be  attached  to  this  state- 
ment, for  those  affected  in  this  way  usually  seek  to 
overcome  this  uncomfortable  feeling  by  rest  or  stimu- 
lants, the  reverse  of  what  is  required. 

Walking  is  more  or  less  monotonous  and  uninterest- 
ing if  done  solely  for  exercise,  particularly  if  one 
walks  alone.  To  overcome  this  pedestrian  clubs  are 
often  formed.  These,  however,  do  not  provide  regular 
daily  exercise;  besides,  there  are  many  who  do  not 
care  to  walk  under  these  conditions.  A  more  pleas- 
ant and  practical  arrangement  is  for  two  or  more  to 
walk  after  the  day's  work  is  over.  At  this  time  exer- 
cise is  of  great  relief  to  both  mind  and  body. 

There  are  many  whose  work  consists  largely  of  man- 
ual labor  and  others  who  are  constantly  moving  about 
in  the  open  air;  in  other  words,  there  are  various 
vocations  which  require  physical  activity.  Those  en- 
gaged in  these  pursuits  have  wholly  or  in  part  com- 
plied with  nature's  demand  for  exercise.  It  is  rather 
those  of  sedentary  habits,  and  more  particularly  brain 
workers,  who  are  closely  confined  during  the  day  and 
often  a  large  part  of  the  night,  year  in  and  year  out, 
to  whom  the  urgent  need  of  walking  especially  applies. 


PERSONAL  HYGIENE  155 

Such  persons  are  more  often  found  in  cities  and  con- 
stitute a  large  part  of  the  city  population.  They  do 
not  often  take  sufficient  or  continued  exercise,  nor  do 
they  appreciate  the  importance  of  it,  as  far  as  the 
preservation  of  their  health  is  concerned. 

There  are  very  few  in  any  station  of  life  who,  if 
they  determine  to  do  so,  cannot  devote  at  least  one 
hour  each  day  to  walking,  and  it  will  not  take  long  to 
prove  to  those  who  undertake  this  the  great  value  of 
open  air  exercise. 

Contrary  to  the  general  belief,  exercise  is  not  inju- 
rious during  the  warm  weather.  It  is  in  fact  essential 
to  health,  except  possibly  during  very  hot  spells.  No 
better  or  more  striking  illustration  of  this  can  be  given 
than  in  the  instance  of  baseball  players.  These  men, 
during  the  hottest  part  of  the  day  and  for  two  or  three 
hours,  are  continuously  engaged  in  the  most  active 
form  of  exercise,  and  it  is  rare  that  cases  of  heat  pros- 
tration occur  among  them.  This  simply  means  that 
by  careful  training  and  proper  care  of  the  body,  a  per- 
son can  develop  a  resisting  power  which  is  little  af- 
fected by  'climatic  conditions.  This  again  serves  to 
remind  us  that  the  preservation  of  health  is  largely  in 
our  own  hands  at  any  season  of  the  year. 

BATHING 

Bathing  in  some  form  is  probably  practised  in 
every  part  of  the  globe,  even  in  uncivilized  countries, 
for  either  cleanliness  or  pleasure.  There  is  a  great 
difference,  however,  in  the  modes  of  bathing  among 
the  various  classes  of  people  throughout  the  world. 


156  GOOD  HEALTH 

It  has  been  said,  and  not  without  some  truth,  that 
the  degree  of  civilization  attained  by  a  people  is 
indicated  largely  by  the  attention  given  to  personal 
cleanliness.  As  a  rule  the  public  takes  little  account  of 
the  real  benefits  to  be  gained  in  this  way  or  the  pleas- 
urable and  satisfactory  means  by  which  they  may  be 
obtained,  although  it  is  important  that  this  should  be 
well  understood. 

The  skin,  through  millions  of  little  ducts,  is  con- 
tinually discharging  waste  matter  from  the  body.  The 
surface  of  the  skin  is  also  supplied  with  a  scaly  layer 
and  a  coating  of  fatty  matter  which  are  being  con- 
stantly renewed  and  thrown  off.  If  these  substances 
are  not  promptly  removed  from  the  skin,  particularly 
in  warm  weather,  they  decompose  and  become  very 
■offensive,  and  the  function  of  the  skin  is  more  or  less 
impaired.  More  important  still,  if  poisonous  products 
formed  in  the  body  are  not  promptly  eliminated 
through  the  kidneys  and  skin,  uncomfortable  or  serious 
results  are  sure  to  follow. 

The  waste  matter  from  the  skin  becomes  particu- 
larly offensive  in  parts  of  the  body  where  surfaces  are 
brought  together  and  where  evaporation  cannot  readily 
take  place,  as  under  the  arms,  between  the  toes,  etc. 
While  this  condition  may  be  tolerated  by  persons  who 
are  careless  regarding  the  proper  care  of  the  body,  it  is 
exceedingly  trying  to  those  who  are  in  close  proximity 
to  them.  No  amount  of  clothing,  powders  or  perfume 
will  mask  the  disagreeable  odors  of  decomposition.  To 
prevent  this  unpleasant  condition  and  to  assist  nature 
in  the  prompt  excretion  of  waste  substances  a  daily 


PERSONAL  HYGIENE  157 

bath  is  desirable,  particularly  in  the  warm  weather,  for 
then  the  skin  is  more  active,  the  amount  of  excretion 
greatly  increased  and  decomposition  more  rapidly 
takes  place. 

The  frequency  with  which  a  person  should  bathe  to 
insure  cleanliness  depends  largely  upon  the  character 
of  the  work  performed,  climatic  conditions  and  other 
factors.  While  the  old  time  weekly  bath  may  in  a 
way  answer  the  purpose  of  cleanliness  during  the  cold 
weather,  it  does  not  maintain  adequately  a  clean  and 
pleasant  condition  of  the  skin  during  the  summer. 
Even  then  a  daily  bath  and  the  free  use  of  soap  and 
water  are  not  always  sufficient  for  this  purpose,  partic- 
ularly about  the  parts  which  are  in  close  contact. 

While  a  tub  bath  is  useful  for  the  weekly  scrubbing, 
it  is  not  as  satisfactory  or  stimulating  as  the  shower 
bath,  and  there  is  no  doubt  that  in  the  future  the  lat- 
ter will  replace  the  tub  for  bathing  purposes. 

It  is  true  that  not  everyone  has  a  tub  or  shower  bath 
at  his  disposal,  but  everyone  can  obtain  a  large  sponge 
at  a  moderate  price,  plenty  of  soap  and  an  ordinary 
wash  tub  or  some  other  simple  receptacle.  Water  is 
always  available,  and  with  this  outfit  the  skin  may  be 
kept  in  good  condition.  Rubber  bath  tubs  may  be  pur- 
chased at  a  comparatively  low  price.  These  can  be 
folded  up,  they  occupy  little  space,  can  easily  be  car- 
ried about  while  traveling,  and  offer  a  very  excellent 
substitute  for  the  ordinary  bath  tub.  Whatever  form 
of  bath  is  selected,  it  must  be  remembered  that  the 
skin  cannot  be  properly  cleaned  without  the  use  of 
soap. 


158  GOOD  HEALTH 

The  temperature  of  the  bath  is  an  important  consid- 
eration. The  very  young,  the  very  old  and  invalids  are 
not  proper  subjects  for  cold  baths  at  any  time.  The 
shock  which  follows  the  sudden  reduction  of  tempera- 
ture of  the  surface  of  the  body  is  not  usually  suc- 
ceeded by  a  prompt  and  healthful  reaction  in  these 
cases,  and  not  infrequently  unpleasant  results  ensue. 
Neither  is  the  practice  of  plunging  into  a  tub  of  cold 
water  in  the  morning,  particularly  in  the  winter,  to  be 
recommended  to  anyone.  While  there  are  persons 
who  apparently  enjoy  this  form  of  bathing,  it  is  quite 
probable  that  sooner  or  later  it  becomes  detrimental 
to  health. 

A  warm  bath  is  valuable  for  cleansing  purposes,  but 
it  is  soothing  rather  than  stimulating,  and  renders  a 
person  quite  susceptible  to  a  lowered  temperature. 
Therefore,  during  cold  weather  warm  baths  should  be 
taken  at  bedtime,  for  outside  exposure  after  a  warm 
bath  would  very  likely  be  followed  by  a  cold  or  some 
more  serious  affection.  During  the  heated  term,  warm 
baths  may  be  commonly  resorted  to  during  the  day  for 
cleansing  purposes  without  any  ill  effects. 

The  most  valuable,  stimulating  and  pleasurable  daily 
bath  for  a  person  in  good  health  is  a  very  warm 
shower  bath  of  short  duration  followed  by  a  cold 
shower  for  the  fraction  of  a  minute  only.  In  this  way 
the  surface  of  the  body  having  been  warmed,  the  cold 
shower  produces  less  shock  thah  if  the  warm  water 
had  not  first  been  applied.  The  cold  shower  alone  is 
not  as  acceptable,  and  certainly  not  as  pleasant  and 
stimulating  as  the  combined  shower.    This  bath  should 


PERSONAL  HYGIENE  '  159 

be  taken  upon  rising  in  the  morning  and  followed  by 
a  brisk  rub  with  a  coarse  towel. 

Turkish  and  Russian  baths  are  not  required  to  main- 
tain a  good,  healthy  condition  of  the  skin.  They  are 
taken  rather  for  their  agreeable  effects,  and  in  some  in- 
stances for  their  remedial  action  in  certain  conditions 
of  disease.  Invalids  and  persons  with  organic  trouble 
should  not  take  these  baths  except  with  the  approval 
of  a  physician. 

A  bath  should  not  be  taken  within  two  or  three 
hours  after  a  meal.  If  the  surface  of  the  body  is  sub- 
jected to  either  extreme  of  temperature  after  digestion 
has  begun,  the  circulation  of  the  blood  in  the  alimen- 
tary tract,  which  during  meal  time  is  adjusted  for  di- 
gestive purposes,  is  affected  sometimes  with  disagree- 
able results. 

Both  fresh  and  salt  water  open  air  bathing  must  be 
placed  in  the  list  of  sports  and  pleasures.  It  is  a  mis- 
taken idea  that  this  kind  of  bathing  is  uniformly  a 
healthful  practice,  for  it  is  not.  Those  who  enjoy 
swimming  invariably  remain  in  the  water  too  long.  In 
case  of  young  persons  the  ill  effect  of  this  is  not  so 
apparent,  but  older  persons  or  very  young  children  are 
very  apt  to  suffer  from  exhaustion  and  extreme  cold- 
ness of  the  surface.  Open  air  bathing,  to  be  quite  pru- 
dent, should  not  last  more  than  ten  or  fifteen  minutes, 
and  should  not  be  indulged  in  soon  after  a  meal. 
Aside  from  the  depression  which  may  occur  as  a  vio- 
lation of  this  rule  by  interfering  with  digestion,  there 
is  little  doubt  that  cramps,  which  often  occur  dur- 
ing swimming  and  which  are  not  infrequently  accom- 


i6o  *  GOOD  HEALTH 

panied  by  serious  and  even  fatal  results,  are  due  to 
digestive  disturbance  following  the  shock  caused  by 
the  reduced  temperature  of  the  water. 

The  blueness  of  the  skin  and  the  shivering,  which 
are  so  commonly  noticed  among  open  air  bathers,  can- 
not be  regarded  as  evidence  that  this  exposure  is  con- 
ducive to  health,  although  at  the  time  it  may  be  fol- 
lowed by  no  unpleasant  symptoms.  One  thing  is  quite 
certain :  this  form  of  bathing  is  not  desirable  or  health- 
ful for  very  young  children  or  for  those  feeble  in 
health  or  advanced  in  years. 

There  is  no  doubt  that  the  depression  and  languor 
which  often  affects  those  who  visit  the  seashores  or 
large  bodies  of  water  where  swimming  is  a  feature  are 
frequently  due  to  prolonged  open  air  bathing.  This 
condition  often  persists  for  some  time  after  a  person 
has  returned  home.  Young  children  are  very  often 
improperly  exposed  in  this  manner. 

TEETH 

The  care  of  the  teeth  is  an  exceedingly  important 
element  in  the  preservation  of  health.  Aside  from 
the  unpleasant  odor  and  appearance  associated  with 
decay,  imperfect  teeth  or  an  insufficient  number  of 
them  sooner  or  later  lead  to  impaired  digestion.  The 
public  is  not  fully  conscious  of  the  possibilities  of  dan- 
ger in  this  direction,  or  the  extent  to  which  it  pre- 
vails. 

A  recent  report  concerning  the  work  of  dental 
clinics  in  New  York  City  shows  that  of  1,694  children 
examined,  only  eleven  had  normal  teeth.    This  at  least 


PERSONAL  HYGIENE  i6r 

indicates  the  necessity  of  more  careful  attention  to 
the  subject.  Its  importance  relates  more  particularly 
to  early  childhood,  and  it  is  wrong  for  parents  or 
guardians  to  omit  the  closest  observation  of  a  matter 
which  will  have  such  a  serious  effect  upon  a  person's 
health,  comfort  and  appearance.  Children  should  be 
taken  regularly  to  a  dentist,  not  only  to  deal  promptly 
with  decay  when  it  exists  but  to  prevent  this  condition. 

Recent  investigation  has  conclusively  shown  that 
diseased  teeth,  tonsils  and  other  centers  of  infection 
are  commonly  responsible  for  rheumatism,  a  very  dis- 
tressing and  often  serious  malady.  It  would  be  diffi- 
cult to  overestimate  the  value  of  this  knowledge,  for  it 
places  in  the  hands  of  the  public,  as  well  as  the  med- 
ical profession,  means  by  which  this  disease  may  often 
be  prevented. 

The  teeth  should  be  thoroughly  brushed  upon  rising 
in  the  morning  and  at  bedtime  with  a  medium-sized 
and  moderately  stiff  brush  for  the  purpose  of  remov- 
ing particles  of  food.  Powder  specially  prepared  for 
cleansing  the  teeth  may  be  purchased  at  a  very  low 
price.  Precipitated  chalk,  which  is  good  for  this  pur- 
pose and  very  inexpensive,  can  be  bought  at  any  drug- 
store. Special  care  in  the  cleanliness  of  the  mouth 
should  be  observed  by  those  who  have  artificial  teeth. 

The  too  frequent  use  of  acid  substances,  such  as 
lemons  and  grapefruit,  is  more  or  less  injurious  to  the 
teeth.  The  bad  effect  of  these  articles  may  be  largely 
neutralized  if  the  mouth  is  afterwards  rinsed  with  a 
solution  of  bicarbonate  of  soda,  about  a  quarter  of  a 
teaspoonful  to  a  glass  of  tepid  water.     This  solution 


i62  GOOD  HEALTH 

may  also  be  used  as  a  mouth  wash  to  dislodge  mai?e 
thoroughly  particles  of  organic  matter. 

EYES 

The  eyes,  like  the  teeth,  do  not  as  a  rule  receive 
proper  attention,  and  unless  some  urgent  sign  or  symp- 
tom of  defective  sight  or  disease  appears,  a  careful 
examination  is  rarely  made.  Great  care  should  be 
taken,  particularly  with  children,  to  detect  any  devia- 
tion from  the  normal  conditions,  in  order  that  it  may 
be  promptly  rectified  and  long  suffering  and  possibly 
loss  of  sight  prevented. 

Continued  headache,  dizziness,  nervousness  and  im- 
paired digestion  are  not  infrequently  caused  by  de- 
fective eyesight,  and  are  often  promptly  cured  by  suit- 
able glasses  or  some  simple  form  of  treatment. 

HANDS    AND    FEET 

The  hands  and  feet  need  very  careful  attention.  In 
the  army  regulations  of  some  countries  may  be  found 
the  most  minute  instructions  as  to  the  care  of  the  feet, 
for  if  they  are  not  kept  in  good  condition  the  soldier 
becomes  unfit  for  service,  as  his  marching  ability  is 
seriously  impaired.  Neglect  and  lack  of  cleanliness 
of  the  feet  are  often  due  largely  to  the  fact  that  they 
are  not  exposed  to  view.  The  feet  should  be  daily 
washed  and  carefully  dried,  particularly  between  the 
toes.  Care  of  the  feet  in  childhood  usually  insures  a 
shapely  foot  in  the  adult. 

Corns,  bunions  and  ingrowing  nails  should  be 
promptly  and  properly  dealt  with.     Sometimes  these 


PERSONAL  HYGIENE  163: 

conditions  require  surgical  treatment.  In  this  case  a 
physician  should  be  consulted,  for  the  danger  of  in- 
fection from  this  source  must  not  be  forgotten.  Tight 
and  ill-fitting  shoes  which  are  sure  to  deform  the  feet 
must  be  carefully  guarded  against,  and  stockings; 
should  be  frequently  changed. 

No  detail  of  personal  hygiene  makes  so  favorable 
an  impression  upon  others  as  clean  hands  and  well 
trimmed  nails.  Attention  to  this  matter  creates  a  most 
favorable  impression  when  seeking  employment.  A 
nail  file  may  be  purchased  at  a  very  low  price,  and  with 
the  vigorous  use  of  a  good  serviceable  nail  brush  twc^ 
or  three  times  a  day,  the  hands  may  be  kept  in  a  very 
presentable  condition.  The  nails  may  be  polished  in 
the  palms  of  the  hands  with  a  little  powder  to  create 
friction.  The  care  of  the  nails  is  not  only  desirable  for 
appearance's  sake,  but  if  they  are  not  properly  cleaned 
it  is  believed  that  they  become  the  repositories  for 
germs. 

SLEEP 

Sleep  is  the  natural  means  of  securing  rest  for  the 
mind  and  the  body.  The  number  of  hours  necessary 
for  this  purpose  depends  largely  upon  occupation  and 
general  condition  of  the  individual. 

Persons  actively  engaged  in  brain  work  or  physical 
exercise  require  more  sleep  than  those  of  inactive  hab- 
its, and  children  need  more  sleep  than  adults.  No' 
definite  rule  can  be  prescribed  as  to  the  proper  length 
of  rest  period,  although  in  a  general  way  it  may  be 
said  that  adults  should  have  from  six  to  eight  hours'' 
sleep,  and  children  eight  to  twelve  hours'.     Sleepless- 


1 64  GOOD  HEALTH 

ness  and  insomnia  are  very  common  affections  and  are 
not  always  difficult  to  overcome  if  the  cause  is  known. 

Sleep,  which  is  nature's  restorer,  will  occur  unless 
ill  health  or  some  temporary  worry  or  excitement  pre- 
vents it.  Therefore,  if  insomnia  exists,  its  cause 
should  be  ascertained  and  removed  rather  than  the 
wakefulness  itself  dealt  with.  Nothing  is  more  inju- 
rious than  a  resort  to  drugs  for  this  purpose.  Medi- 
cines which  cause  sleep  almost  always  weaken  the 
heart  and  depress  the  general  system,  and  in  various 
ways  may  delay  a  return  to  the  normal  condition  of 
health,  which  is  the  object  in  view^  Moreover,  the  use 
of  drugs  to  produce  sleep  is  very  apt  to  lead  to  a  dan- 
gerous and  pernicious  habit,  and  too  much  cannot  be 
said  in  condemnation  of  the  many  remedies  which  are 
advertised  for  this  purpose.  A  person  who  suffers 
from  insomnia  for  a  protracted  period  is  not  in  a  nor- 
mal condition  of  health  and  should  consult  a  physician. 
He  should  not  resort  to  the  use  of  so-called  sleep- 
producing  agents. 

During  sleep  the  heart  and  lungs  are  less  active,  and 
imder  these  conditions  it  is  essential  that  the  dimin- 
ished amount  of  air  consumed  should  be  as  fresh  as 
possible.  Free  ventilation  during  sleeping  hours  is 
therefore  of  the  greatest  importance  in  order  that  suf- 
ficient oxygen  for  respiration  may  be  obtained.  Out- 
side air,  particularly  when  cold,  supplies  a  greater 
quantity  of  oxygen  in  a  given  amount  than  that  within 
the  house.  Instinctively  a  person  whose  respiration 
is  suddenly  restricted  will  open  the  windows  to  breathe 
the  outside  air. 


PERSONAL  HYGIENE  165 

The  habit  of  sleeping  out  of  doors  or  with  the  win- 
dows of  the  apartment  wide  open  is  now  largely  prac- 
tised. It  must  be  remembered,  however,  that  notwith- 
standing the  desirability  of  plenty  of  fresh  air  in  the 
sleeping  room,  drafts  must  be  avoided,  and  though  the 
head  is  exposed,  the  body  should  be  kept  warm.  In 
certain  diseases,  particularly  in  tuberculosis  of  the 
lungs,  fresh  air  has  a  special  and  largely  curative 
value.  While  free  exposure  to  the  outside  air  is  very 
important  in  this  affection,  it  is  not  required  that 
healthy  persons  should  provide  for  more  than  a  well 
ventilated  sleeping  room.  Furthermore,  it  must  be  re- 
membered that  persons  suffering  from  certain  condi- 
tions of  the  throat,  nose  and  ears,  and  those  in  feeble 
health  or  advanced  in  years  are  often  made  uncomfort- 
able and  unfavorably  affected  by  too  much  exposure  to 
cold  air  and  drafts  during  the  night.  While  the  sleep- 
ing room  should  be  well  ventilated  it  is  very  desirable 
that  the  dressing  or  bathroom  be  comfortably  warm 
in  order  that  the  exposed  surface  of  the  body  upon 
rising  is  not  chilled  by  the  greatly  reduced  tem- 
perature. 

A  word  may  be  said  regarding  the  equipment  of 
the  bed.  A  reasonably  hard  mattress  is  best  to  sleep 
upon.  A  feather  bed  should  not  find  a  place  in  any 
home.  During  sleep  the  pressure  of  blood  in  the  brain 
is  diminished  in  order  that  this  organ  may  obtain  rest. 
Elevation  of  the  head  not  too  high  while  in  bed  aids 
this ;  therefore  pillows  are  used.  This  habit  is  so  gen- 
erally accepted  that  it  goes  far  to  establish  the  need  of 
support  of  the  head  during  sleep.   Although  some  per- 


i66  GOOD  HEALTH 

•sons  sleep  without  pillows  apparently  with  comfort, 
this  is  individual  preference  and  does  not  prove  it  to 
he  a  good  healthful  course  for  everyone  to  follow. 

CLOTHING 

While  from  a  general  standpoint  the  need  of  cloth- 
ing is  too  well  understood  to  call  for  comment,  the 
importance  of  wearing  garments  suitable  for  the  vari- 
ous climatic  conditions  is  not  so  well  appreciated. 

The  materials  usually  employed  in  the  manufacture 
of  clothing  are  linen,  cotton,  wool,  silk  and  fur.  Cotton, 
and  linen  are  good  conductors  of  heat  and  cold;  that  is, 
the  warmth  of  the  body  passes  quickly  through  these 
fabrics  into  the  outer  world  and  the  cold  enters  from 
without,  therefore  they  do  not  offer  the  'protection  af- 
forded by  wool  and  silk  which  are  very  poor  conduct- 
ors. Besides,  cotton  and  linen  are  not  so  hygroscopic 
as  wool  and  silk;  that  is,  the  individual  fibers  of  the 
former  materials  do  not  absorb  and  give  off  water  as 
slowly  as  in  the  case  of  wool  and  silk,  but  allow  it  to 
•evaporate  quickly.  As  a  very  familiar  example  of  this, 
when  cotton  or  linen  underclothing  becomes  wet  from 
perspiration  in  the  summer  evaporation  takes  place  so 
rapidly  that  the  body  becomes  quite  cold,  whereas  if 
wool  is  used,  the  chilling  takes  place  more  slowly. 
Silk  has  to  some  extent  the  properties  of  wool  just  re- 
ferred to,  and  is  sometimes  used  as  a  substitute  for  it. 

In  this  country  fur  need  only  be  considered  as  an 
outer  garment  for  extremely  cold  weather,  while  in 
sections  of  the  world  where  the  temperature  is  con- 
stantly very  low  it  is  used  as  a  common  article  of  cloth- 


PERSONAL  HYGIENE  167 

ing.  The  value  of  fur  lies  in  its  impermeability  to  cold 
and  winds.  The  great  protection  against  cold  fur- 
nished by  a  fur  coat  is  due  not  only  to  the  skin  sur- 
face, but  also  to  the  very  large  amount  of  air  contained 
in  the  meshes  of  the  fur.  Air  is  a  very  poor  conductor 
of  heat  and  cold,  and  for  this  reason  loosely  woven 
fabrics  which  contain  air  in  their  meshes  are  warmer 
than  those  which  are  closely  woven.  Two  or  three 
layers  of  clothing  are  warmer  than  one  of  equal  thick- 
ness because  there  is  air  between  the  various  layers.. 
This  explains  why  several  layers  of  paper  wrapped 
around  the  body  or  placed  over  the  bed  covering  is  a 
valuable  protection  against  the  cold.  In  emergencies, 
newspapers  may  be  used  for  this  purpose. 

All  garments  used  for  clothing  should  be  porous  to 
admit  the  air;  otherwise  the  function  of  the  skin  is  ma- 
terially interfered  with.  For  this  reason  mackintoshes,, 
and  leather  or  rubber  clothing  are  not  good  or  health- 
ful for  continued  wear. 

The  choice  of  clothing  depends  largely  upon  climatic 
conditions.  The  selection  for  the  cold  season  gener- 
ally includes  a  change  both  in  the  outer  and  under  gar- 
ments and  the  addition  of  great  coats  and  wraps  for 
outside  exposure. 

It  would  be  difficult  to  describe  the  numerous  styles 
and  fabrics  used  for  underwear,  the  value  of  many  of 
them  being  largely  theoretical.  While  various  articles 
are  recommended,  there  is  but  one  material  which  f  rom 
a  practical  and  scientific  standpoint  is  entitled  to  gen- 
eral approval  for  winter  underwear,  and  that  is  wooL 
Wool  offers  the  best  protection  against  cold,  for  it  is. 


i68  GOOD  HEALTH 

a  very  poor  conductor  of  heat.  While  it  helps  to 
retain  the  body  heat  it  also  aids  very  effectively  in 
preventing  the  chilling  effect  of  the  external  tempera- 
ture upon  the  body.  Cotton  is  the  least  valuable  for 
this  purpose,  while  silk  probably  occupies  a  position 
between  wool  and  cotton.  Some  wear  cotton  under- 
clothing throughout  the  year  apparently  with  comfort ; 
yet  this  does  not  prove  that  it  is  of  the  same  value  as 
wool  for  general  use. 

It  is  not  necessary  that  undergarments  should  be 
composed  entirely  of  wool.  While  a  mixture  of 
twenty-five  per  cent  of  cotton  does  not  materially  af- 
fect the  protective  value  of  the  material,  it  renders  it 
more  agreeable  to  the  skin  and  prevents  excessive 
shrinking  during  the  process  of  washing.  This  latter 
result,  it  must  be  observed  in  passing,  has  been  largely 
overcome  by  modern  laundry  methods. 

Not  only  the  material,  but  the  weight,  of  the  winter 
undergarments  should  be  considered.  It  is  a  common 
practice  to  have  those  of  but  one  thickness  for  winter 
use,  whereas  everyone  should  be  supplied  with  two 
weights  to  insure  comfort.  During  the  winter  the 
weather  often  becomes  mild  and  continues  so  for  a 
number  of  days,  and  if  the  underclothing  is  too  heavy 
the  skin  becomes  moist  and  tender  and  renders  a  per- 
son more  susceptible  to  colds. 

Colored  underclothing  has  no  special  value  and 
should  not  be  used,  particularly  in  cheap  material,  for 
the  dye  is  very  apt  to  come  off  and  produce  more  or 
less  irritation  of  the  skin. 

Upon  the  approach  of  winter  it  is  the  custom  to  sub- 


PERSONAL  HYGIENE  169 

stitute  heavier  outer  clothing  for  that  worn  during  the 
summer.  While  it  is  important  that  serviceable  woolen 
undergarments  should  be  provided  for  cold  weather,  a 
change  in  the  weight  and  material  of  the  outside  cloth- 
ing is  not  only  unnecessary  but  is  responsible  for  much 
discomfort  and  ill  health. 

During  the  winter,  particularly  in  cities  and  towns, 
persons  usually  remain  indoors  not  less  than  twenty 
out  of  twenty-four  hours,  often  in  apartments,  work- 
shops or  offices  where  the  temperature  is  too  high ; 
sometimes  reaching  eighty  or  more  degrees.  This  is 
practically  summer  heat,  but  without  the  fresh  air 
which  is  available  during  summer,  for  the  windows  are 
kept  carefully  closed.  In  these  insanitary  surroundings 
a  person  who  is  too  heavily  clad  is  not  only  made  un- 
comfortable, but,  as  stated  above,  the  skin  is  very  apt 
to  become  moist  and  tender  and  in  this  condition  very 
sensitive  to  the  lowered  outdoor  temperature  which  is 
often  thirty  or  forty  degrees  below  that  of  the  interior 
of  the  house.  There  is  no  doubt  that  exposure  to  these 
rapid  and  extreme  variations  of  temperature  under 
the  conditions  just  referred  to,  is  often  directly  respon- 
sible for  the  different  cold  weather  ailments. 

The  fact  is  that  during  the  cold  weather  heavy  and 
uncomfortable  outer  garments  are  worn  within  doors, 
in  order  to  afford  protection  against  a  brief  period  of 
exposure  upon  going  outside ;  whereas  our  dress 
should  rather  be  adjusted  to  the  temperature  of  the 
interior,  and  then  heavy  overcoat  or  ulster  added  upon 
leaving  the  building.  These  wraps  are  made  to  cover 
almost  the  entire  body. 


170  GOOD  HEALTH 

It  is  far  more  comfortable  and  reasonable  and  more 
conducive  to  health  to  wear  outer  garments  of  the 
same  texture  and  weight  throughout  the  year,  except 
possibly  in  midsummer  when  clothing  made  of  very 
thin  material  of  ''tropical  weight"  is  appropriate. 
Those  who  have  adopted  this  logical  mode  of  dress 
are  fully  convinced  of  the  comfort  and  protection 
which  it  affords,  particularly  within  doors. 

It  is  also  important  that  special  protection  be  pro- 
vided for  the  feet  during  the  cold  and  wet  weather, 
for  carelessness  in  this  direction  is  a  common  cause  of 
colds,  sore  throats  and  other  uncomfortable  and  dan- 
gerous affections.  Boots  and  shoes,  which  are  really 
waterproof  exist  chiefly  in  the  imagination,  and  offer 
little  or  no  protection.  Everyone  should  be  provided 
with  rubbers  and  overshoes,  and  should  use  them 
when  the  streets  are  damp,  wet  or  covered  with 
snow.  Unfortunately,  this  very  valuable  form  of  pro- 
tection is  not  popular,  at  least  in  this  country ;  besides, 
complaint  is  often  made  that  they  cause  the  feet  to 
sweat.  This  complaint  is  largely  groundless,  for  rub- 
bers do  not  interfere  with  comfort  if  they  are  promptly 
removed  upon  entering  the  house.  Proper  protection 
for  the  feet  and  a  moderate  temperature  in  apartments 
during  the  winter  months  are,  as  far  as  the  preserva- 
tion of  health  is  concerned,  far  more  important  than 
the  public  realizes. 

In  selecting  appropriate  clothing,  particularly  for 
warm  weather,  a  knowledge  of  the  heat-absorbing 
qualities  of  the  different  textile  fabrics  is  of  value.  It 
seems  to  be  well  proven  that  white  attracts  the  heat 


PERSONAL  HYGIENE  171 

less  than  colors,  and  is  therefore  the  coolest  for  sum- 
mer wear,  while  black  is  the  warmest.  For  this  pur- 
pose custom  and  experience  have  so  well  indicated  the 
dress  which  is  most  comfortable  during  the  warm 
weather,  that  there  is  little  to  be  said  on  the  subject. 
It  is  not  generally  known,  however,  that  thin  under- 
garments containing  some  wool  are  actually  far  more 
agreeable  than  those  composed  entirely  of  cotton,  for 
there  is  far  less  chilling  effect  when  they  become  wet 
with  perspiration. 

Undergarments  must  be  changed  frequently,  for 
when  they  become  soaked  with  perspiration  containing 
decomposed  matter  from  the  skin,  they  are  sure  to  be- 
come offensive  and  retain  an  unpleasant  odor.  Dry- 
ing and  airing  does  not  remove  the  odor. 

Variations  in  climatic  conditions  not  only  require 
change  in  our  mode  of  dress,  but  in  eating  and  other 
details  connected  with  the  care  of  the  body.  It  is  quite 
true  that  a  young  person  in  good  health  would  probably 
be  able  to  pass  through  the  entire  year  with  but  little 
or  no  change  of  dress,  bathing,  exercise  and  food,  and 
still  avoid  any  unpleasant  consequences.  On  the  other 
hand,  as  we  grow  older  or  where  sickness  occurs,  or 
where  the  rules  of  health  are  violated,  the  resisting 
power  of  the  body  becomes  lessened  and  must  in  vari- 
ous ways  be  compensated  for. 

CONSTIPATION 

An  important  detail  connected  with  the  preservation 
of  health  which  receives  far  too  little  attention  is  the 
proper  care  of  the  bowels  and  the  avoidance  of  con- 


172  GOOD  HEALTH 

stipation.  Constipation  leads  to  all  sorts  of  unfavor- 
able conditions,  chiefly  the  absorption  of  poisonous 
products  from  the  intestines. 

The  cause  of  constipation  in  the  absence  of  organic 
disease  is  due  chiefly  to  the  loss  of  tone  and  activity 
of  the  muscular  coat  of  the  intestines,  the  function  of 
which  is  to  keep  the  intestines  active  during  the  diges- 
tion of  food  and  to  remove  from  the  body  waste  mat- 
ter resulting  largely  from  digestion.  Constipation 
is  usually  the  result  of  sedentary  habits,  improper  food 
and  intemperance  in  eating  and  drinking.  Unless  this 
subject  is  given  proper  consideration  in  early  life, 
chronic  constipation,  which  is  exceedingly  difficult  to 
overcome,  frequently  follows. 

As  constipation,  particularly  in  an  obstinate  form, 
is  not  a  normal  condition,  it  may  usually  be  avoided  in 
a  healthy  person.  In  general  the  preventive  measures 
relate  to  the  proper  care  of  the  body,  or  personal  hy- 
giene, especially  the  use  of  suitable  and  simple  food, 
sufficient  water  and,  most  important  of  all,  plenty  of 
regular  exercise  in  the  open  air,  preferably  walking. 
Whole  grain  food,  which  stimulates  the  intestinal  tract, 
and  plenty  of  vegetables  and  fruit  aid  in  preventing 
constipation.     Oatmeal  is  very  valuable  in  this  way. 

A  glass  of  cold  water  before  breakfast  or  a  glass  of 
hot  water  at  bedtime  and  many  other  simple  and  ef- 
fective means  of  encouraging  the  action  of  the  bowels 
are  in  general  use.  They  must  not  be  accepted,  how- 
ever, as  substitutes  for  the  dietary  measures  just  re- 
ferred to. 

If  constipation  persists  there  is  some  reason  for  it 


PERSONAL  HYGIENE  173 

and  a  physician  should  be  consulted.  If  the  services 
of  a  physician  are  not  available,  some  harmless  agent 
may  be  employed  for  temporary  purposes.  Probably 
the  best  of  these  is  castor  oil;  licorice  powder  or  one 
of  the  saline  laxatives  may  also  be  used.  On  the  other 
hand,  nothing  is  more  pernicious  than  the  continued 
use  of  cathartics,  and  the  temptation  in  this  direction  is 
very  great,  for  they  are  advertised  everywhere.  These 
drugs  not  only  do  not  relieve  the  constipation,  but  as 
a  rule  aggravate  it. 

One  thing  in  connection  with  this  subject  should  be 
particularly  borne  in  mind,  and  that  is  the  importance 
of  not  only  responding  promptly  to  the  calls  of  nature 
but  establishing  a  regular  time  for  this  purpose,  prefer- 
ably in  the  morning.  Attention  to  this  goes  far  to  pre- 
vent constipation. 

VACATIONS 

Everyone,  no  matter  what  his  station  of  life,  should 
have  at  least  a  short  period  of  relaxation  or  change 
of  environment  during  the  year.  This  is  really  an 
important  economic  consideration,  for  with  this  aid  a 
person  can  not  only  recuperate  in  health  but  render 
better  service  in  his  work. 

Abroad,  the  public  has  learned  through  the  experi- 
ence of  centuries  the  value  of  providing,  particularly 
for  the  poorer  classes  within  municipal  boundaries,  at- 
tractive and  pleasant  means  of  relaxation.  For  a  time 
at  least,  this  takes  them  away  from  their  troubles  as 
well  as  unhealthy  surroundings,  particularly  during 
the  summer  months. 

It  is  true,  a  vacation,  particularly  in  the  summer,  is 


174  GOOD  HEALTH 

a  very  important  factor  in  preserving  a  good  physical 
condition  and  mental  equipoise.  A  large  part  of  the 
population  cannot  enjoy  this  pleasure,  but  must  depend 
upon  some  sort  of  day  and  night  entertainment  and 
relaxation  which  may  be  obtained  at  home.  Unfor- 
tunately the  great  mass  of  people  in  this  country  do 
not  select  the  recreation  which  is  of  most  value  to 
them.  In  this  we  are  far  behind  European  countries, 
for  there  they  secure  the  most  suitable  and  most  val- 
uable means  of  rest  and  comfort  at  a  minimum  cost. 

Observing  foreigners  as  well  as  others,  who  watch 
the  struggling  mass  of  humanity  who  daily  visit  our 
seaside  resorts  with  little  children,  and  are  packed  in 
crowded  cars  both  coming  and  going,  who,  while 
at  these  resorts,  are  encouraged  at  every  point  to 
partake  of  improper  food  and  drink,  and  who  return 
home  at  night,  tired,  sunburned  and  irritable — all  at  a 
considerable  outlay — cannot  quite  understand  what  ad- 
vantage is  obtained  from  this  form  of  so-called  pleas- 
ure. Little  benefit  is  derived  from  the  sea  air  in  a  day's 
excursion,  particularly  when  the  weather  is  hot  and 
there  is  constant  exposure  to  the  rays  of  the  sun.  The 
quieter  inland  places  should  be  selected  for  a  day's  out- 
ing. There  are  many  such  places  where  shade  and 
comfortable  temperature  may  be  found  as  well  as  an 
abundant  supply  of  good  drinking  water,  the  last 
being  a  very  important  consideration.  A  luncheon 
taken  from  home  offers  more  gratification  than  the 
food  and  drink  purchased  at  the  summer  resorts,  and 
the  environment  last  described  promises  a  much  better 
opportunity  for  rest  and  recuperation. 


PERSONAL  HYGIENE  175 

Neither  the  warm  nor  the  cold  term  should  be  re- 
garded as  an  evil,  but  should  rather  be  recognized  as 
making  up  the  normal  climatic  conditions  of  the  chang- 
ing year.  We  shall  not  suffer  unduly  if  we  keep  our- 
selves in  a  healthful  condition  by  obedience  to  simple 
rules  and  an  intelligent  preparation  for  the  weather 
and  temperature  which  characterize  our  seasons. 

Hot  and  cold  weather,  like  disease,  usually  select  for 
their  victims  those  who  are  in  poor  health  or  who 
are  careless  of  their  physical  condition.  Those  who 
have  good  resisting  power  are  but  little  affected  by 
climatic  change^. 


CHAPTER  X 

HYGIENE   OF   THE   HOME,    SCHOOL   AND   WORKSHOP 

HYGIENE  OF  THE  HOME 

While  proper  care  of  the  body  is  necessary  in 
maintaining  a  healthful  condition,  there  are  other  very 
important  contributory  factors.  Of  these  the  most 
effective  are  cleanliness  of  environment  and  the  early 
detection  and  proper  care  of  infectious  diseases. 

There  is  no  hygienic  measure  so  productive  of  good 
results  as  cleanliness.  Lack  of  this  renders  the  in- 
terior of  the  house  offensive  and  unhealthful,  and  di- 
rectly or  indirectly  leads  to  other  insanitary  condi- 
tions. The  observance  of  it,  chiefly  through  the  free 
use  of  soap  and  water,  and  not  deodorants  or  disin- 
fectants, must  be  depended  upon  to  keep  the  house 
wholesome.  Disinfectants  are  called  for  only  in  the 
presence  of  infectious  diseases ;  then  they  should  be 
selected  by  and  used  under  the  direction  of  the  family 
physician. 

In  the  construction  of  dwelling  houses,  every  rea- 
sonable provision  should  be  made  to  render  cleaning 
easy.  If  the  means  of  the  household  are  limited, 
money  intended  for  carpets  should  be  spent  rather  for 
well  built  and  closely  laid  floors  which  can  be  easily 
cleaned.     They  are  also  better  and  more  sanitary  in 

176 


HOME,  SCHOOL  AND  WORKSHOP  177 

other  ways.  Good  serviceable  rugs  add  very  much  to 
the  appearance  of  the  floor  and  are  not  objectionable, 
but  carpets  are  insanitary,  for  they  rapidly  accumulate 
dirt  and  are  lodging  places  for  organic  matter,  the 
unpleasant  odors  of  which  cannot  be  removed  unless 
the  carpet  is  taken  up  and  renovated. 

Furniture  makers  of  the  present  day  have  contrib- 
uted much  to  the  proper  and  sanitary  equipment  of 
the  house  by  making  plain  and  light,  as  well  as  com- 
fortable, articles  of  furniture,  which  are  easier  to 
clean  than  those  of  older  styles.  This  principle,  as  far 
as  practicable,  should  be  carried  out  in  the  dressing 
of  the  various  rooms  throughout  the  house.  It  is  not 
intended  that  pleasing  ornamentation  should  be  dis- 
couraged, but  the  importance  of  cleanliness  is  not  to 
be  overlooked. 

In  recent  years,  a  method  of  indoor  cleaning  has 
been  devised  which  accomplishes  the  removal  of  dirt 
and  dust  and  is  of  great  practical  and  sanitary  value, 
and  bids  fair  to  become  the  ideal  means  of  doing  this 
work.  It  is  not  only  effective  in  action,  but  prevents 
the  distribution  of  dust  about  the  apartment  which  al- 
ways occurs  when  the  ordinary  methods  of  sweeping 
are  employed.  This  is  known  as  the  'Vacuum  proc- 
ess," and  acts  by  a  powerful  suction  force.  Portable, 
efficient  and  comparatively  cheap  apparatus  may  be 
purchased  as  low  as  six  or  seven  dollars;  their  use  is 
strongly  recommended.  If  a  broom  must  be  used,  a 
piece  of  wet  cloth  should  be  wrapped  about  the  bot- 
tom to  prevent  dust  flying  about.  It  must  be  remem- 
bered, however,  that  neither  the  vacuum  process  nor 


178  GOOD  HEALTH 

ordinary  sweeping  removes  the  tenacious,  greasy  mat- 
ter attached  to  woodwork.  Soap  and  water  cannot  be 
dispensed  with  in  any  plan  of  house  cleaning. 

There  are  at  least  two  rooms  in  the  house  which 
call  for  special  attention  as  regards  cleanliness :  these 
are  the  kitchen  and  the  apartment  where  foodstuff  is 
stored.  Many  housewives  believe  that  soap  and  wa- 
ter are  not  adequate  to  keep  rooms  in  good  sanitary 
condition,  and  are  persuaded  to  substitute  all  sorts  of 
disinfectants  and  deodorants.  Such  agents  are  not 
necessary  for  cleaning  purposes,  for  filth  and  dirt 
should  he  removed  and  not  treated.  The  most  effec- 
tive means  of  accomplishing  this  is  by  the  free  use  of 
soap  and  water,  which  always  secures  the  desired  re- 
sult if  properly  employed.  A  solution  of  one  pound 
of  washing  soda  in  three  gallons  of  hot  water  is  also 
valuable  for  this  purpose. 

The  woodwork  in  and  about  the  kitchen  and  store- 
room and  the  various  receptacles  for  food  and  waste 
products  should  be  frequently  and  thoroughly  scrubbed 
and  cleaned  to  prevent  the  accumulation  of  decompos- 
ing organic  matter  which  is  responsible  for  the  un- 
pleasant odor  so  frequently  noticed  in  these  places. 

The  view  from  the  back  door  of  the  kitchen  in  a 
country  home  is  not  always  inviting,  for  it  sometimes 
discloses  the  presence  of  a  large  amount  of  refuse 
matter.  This  is  not  only  unpleasant  but  it  furnishes  a 
favorite  breeding  place  for  insects,  some  of  which  may 
act  as  media  of  infection. 

The  most  scrupulous  attention  should  be  paid  to  the 
icebox.     Among  the  food  products  it  contains  there 


HOME,  SCHOOL  AND  WORKSHOP  179 

are  articles  which  decompose  and  become  offensive 
even  after  all  the  contents  are  removed.  For  this 
special  purpose,  brushes  of  all  kinds  and  shapes  may 
be  purchased  for  a  small  price,  and  inexpensive  soaps 
and  simple  cleaning  powders,  which  *'cut"  and  remove 
the  greasy  matter,  can  be  purchased  everywhere. 

At  the  present  day,  so  many  types  of  iceboxes 
are  offered  for  sale  that  there  is  no  difficulty  in  select- 
ing one  which  is  satisfactory  in  make,  size  and  price. 
An  icebox  should  be  so  constructed  that  it  is  a  non- 
conductor of  heat,  in  order  that  the  high  temperature 
outside  will  not  be  transmitted  to  the  articles  con- 
tained in  this  receptacle.  Furthermore,  the  icebox 
should  be  lined  with  porcelain  or  some  glazed  material 
which  can  be  properly  and  thoroughly  cleaned. 

An  unclean  kitchen,  storeroom  or  icebox  reflects 
unpleasantly  upon  those  in  charge,  for  the  means  for 
preventing  this  condition  are  within  the  reach  of  all, 
rich  and  poor. 

Boiling  water  may  be  depended  upon  to  destroy  all 
germs.  The  various  table  utensils  may  be  freed  from 
contamination  by  this  means,  provided  they  are  placed 
in  water  and  constantly  boiled  for  at  least  five  minutes. 
It  is  also  important  that  the  cellar  should  be  kept 
carefully  cleaned  and  the  walls  and  floors  properly 
cemented.  If  the  latter  are  not  impermeable,  offensive 
fluids  and  gases  may  enter  from  the  surrounding  soil 
and  contaminate  foodstuff,  particularly  milk.  An  oc- 
casional coat  of  whitewash  provides  a  simple  means 
of  keeping  a  well  constructed  cellar  free  from  un- 
pleasant odors. 


i8o  GOOD  HEALTH 

Sinks  and  receptacles  used  for  slops  and  other 
waste  matter  throughout  the  house  should  be  planned 
for  most  painstakingly  to  insure  cleanliness.  About 
the  premises,  particularly  in  the  country,  there  are 
cesspools  and  drains  to  deal  with,  which  are  often 
more  or  less  offensive,  and  not  infrequently  there  are 
dead  animals  and  collections  of  decomposing  matter 
which  for  the  moment  cannot  be  buried,  removed  or 
burned.  Under  these  conditions,  the  use  of  deodo- 
rants is  called  for.  The  combination  of  sulphate  of 
copper  and  lime  and  water  mentioned  in  the  chapter 
on  deodorants  is  of  value  for  this  purpose. 

The  great  importance  of  promptly  detecting  the 
presence  of  infectious  diseases  will  be  referred  to  in 
another  chapter.  It  is  not  expected  that  the  members 
of  a  family  will  be  competent  to  diagnose  a  case  of 
sickness  which  may  occur  in  the  household,  and  so 
it  is  their  duty  to  obtain  promptly  medical  advice  in 
order  that  the  media  of  infection  may  be  detected  and 
the  proper  course  taken  to  prevent  the  spread  of  dis- 
ease, principally  through  the  careful  isolation  of  the 
patient. 

The  urgent  need  of  proper  toilet  facilities  is  often 
unfortunately  overlooked.  In  the  country  it  generally 
consists  of  an  outdoor  privy  vault,  often  in  full  view 
of  the  passerby.  In  this  situation  inclement  weather 
and  the  discomfort  of  a  night  visit  or  other  circum- 
stances often  deter  persons  from  promptly  answering 
the  call  of  nature,  which  is  not  without  injury  to 
health.  At  present  there  is  little  excuse  for  this  con- 
dition of  affairs,  for  modern  equipment  for  the  dis- 


HOME,  SCHOOL  AND  WOI^KSHOP  i8i 

posal  of  waste  may  now  be  installed  at  a  compara- 
tively low  price. 

To  secure  comfort  as  well  as  protection  against  in- 
fection, flies,  mosquitoes  and  other  insects  should  be 
excluded  from  the  home.  The  most  practical  method 
of  doing  this  is  by  the  use  of  properly  constructed 
wire  screens  which  prevent  the  entrance  of  these  in- 
sects into  the  house,  rather  than  by  fly  "swatters." 

HYGIENE  OF  THE  SCHOOL 

Much  has  been  written  regarding  the  construction, 
ventilation,  heating  and  lighting  of  schoolhouses,  and 
the  proper  means  of  equipping  them.  While  these  are 
very  necessary  details,  their  consideration  should  not 
obscure  the  great  importance  of  a  daily  visual  inspec- 
tion of  children  at  school  for  the  purpose  of  promptly 
detecting  any  deviation  from  health,  particularly  the 
presence  of  infectious  diseases. 

If  children  are  in  poor  health  they  should  not  be  al- 
lowed to  study  or  remain  in  school.  The  responsibility 
of  this  rests  largely  upon  the  teacher.  A  daily  visual 
examination  of  children,  whether  it  is  in  the  public  city 
school  or  the  district  schoolhouse  in  the  country,  is 
neither  impracticable  nor  diflicult,  nor  is  it  necessary 
that  this  procedure  should  annoy  or  interfere  with  the 
comfort  of  children  during  their  hours  of  study,  reci- 
tation and  recreation;  for  they  need  not  be  especially 
informed  that  this  method  of  daily  observation  is  be- 
ing carried  out. 

The  preservation  of  a  child's  health  depends  largely 
upon  care  and  observation  on  the  part  of  his  teacher, 


i82  GOOD  HEALTH 

as  a  large  percentage  of  children  spend  most  of  the 
day  in  school  and  at  play,  and  not  under  the  obser- 
vation of  their  parents.  Therefore  it  is  very  essen- 
tial that  teachers  should  be  familiar  with  conditions 
which  indicate  a  deviation  from  health,  and  also  have 
an  elementary  knowledge  of  the  early  signs  and  symp- 
toms of  the  various  infectious  diseases  which  com- 
monly affect  children. 

Not  only  should  a  daily  visual  examination  be  made 
for  the  detection  of  infectious  diseases,  but  teachers 
should  observe  the  children  under  their  care  to  detect 
defective  eyesight,  imperfect  hearing,  the  presence  of 
adenoids,  diseased  tonsils  and  defective  and  decayed 
teeth.  ]\Iuch  can  be  done  to  relieve  these  conditions 
if  they  are  promptly  recognized  and  quickly  dealt 
with,  and  little  help  can  be  extended  if  they  are  al- 
lowed to  go  too  long  without  proper  care.  Teachers 
should  also  carefully  observe  if  children  are  improp- 
erly clad  and  if  there  is  evidence  that  they  are  in- 
sufficiently nourished. 

It  was  formerly  believed  that  the  increased  number 
of  cases  of  infectious  diseases  among  children  at  the 
beginning  of  the  school  year  was  largely  due  to  the 
transmission  of  infectious  matter  by  their  clothing 
from  homes  where  disease  exists.  This  is  not  the  true 
explanation,  for  diseases  are  transmitted  in  this  way 
only  in  rare  instances.  Indisputable  evidence  has  been 
presented  proving  that  cases  of  infectious  diseases  are 
conveyed  by  mild  and  unrecognized  cases  and  by  "car- 
riers." These  are  commonly  found  in  schools,  and 
constitute  active  media  of  infection. 


HOME,  SCHOOL  AND  WORKSHOP  183 

Very  successful  results  have  followed  the  work  of 
"school  corps,"  whose  function  consists  in  the  fre- 
quent examination  of  school  children  to  detect  the 
presence  of  infectious  disease  or  conditions  which  may 
unfit  them  for  study.  Unfortunately,  school  corps 
are  available  only  in  large  cities,  so  that  the  visual  ex- 
amination of  school  children  in  smaller  places,  particu- 
larly in  the  country,  must  be  placed  in  the  hands  of 
the  teachers,  but  always  under  the  general  direction 
of  some  medical  officer. 

If  a  child  is  apparently  in  poor  health  or  presents 
symptoms  suspicious  of  infectious  disease,  he  should 
be  quietly  sent  home  with  a  communication  to  the  par- 
ents requesting  that  a  prompt  examination  be  made  by 
a  physician,  and  a  report  forwarded  as  to  the  diagno- 
sis of  the  case.  This,  is  necessary  for  the  protection 
of  schoolmates  as  well  as  the  affected  child. 

A  cold  in  the  head  with  suffused  or  congested  eyes 
are  symptoms  which  usher  in  measles,  and  a  sore 
throat  may  be  the  forerunner  of  diphtheria  or  scarlet 
fever,  while  a  few  spots  just  appearing  on  the  skin 
may  be  the  onset  of  smallpox  or  some  other  eruptive 
disease.  When  such  evidence  of  ill  health  or  disease 
is  presented,  teachers  should  lose  no  time  by  suggest- 
ing remedies  or  various  modes  of  treatment,  for  they 
are  not  qualified  to  do  this,  but  in  the  interest  of  all 
concerned  they  should  endeavor  as  promptly  as  pos- 
sible to  place  the  child  in  the  hands  of  the  family  phy- 
sician. 

Teachers  should  carefully  observe  the  manner  in 
which  children  study  and  they  must  not  assume  that 


184  GOOD  HEALTH 

they  are  relieved  from  this  obligation  because  modern 
seats  or  other  equipment  has  been  installed;  neither 
should  they  overlook  the  need  of  a  daily  observation 
as  to  ventilation,  heating  and  lighting  because  others 
may  be  directly  responsible  for  this  condition. 

The  proper  ventilation  of  a  schoolhouse  cannot  be 
determined  by  measurements  or  by  a  theoretical  esti- 
mate of  the  number  of  cubic  feet  of  air  required  for 
each  person,  although  a  knowledge  of  this  is  neces- 
sary in  order  that  there  may  be  a  scientific  standard  to 
work  upon.  Those  in  charge  of  the  ventilation  of 
schoolhouses  away  from  great  centers  will  perform 
their  part  if  they  have  learned  the  great  need  of  fresh 
air  and  the  simplest  means  by  which  it  may  be  ob- 
tained. 

In  the  construction  of  new  school  buildings,  the 
question  of  ventilation,  heating,  lighting  and  sanitary 
arrangement  may  properly  be  left  to  the  architect.  It 
is  where  old  structures  are  used  as  schoolhouses,  par- 
ticularly in  the  country,  that  special  effort  is  required 
on  the  part  of  those  in  charge  of  educational  matters, 
to  render  these  buildings  good  enough  for  school  pur- 
poses. 

It  is  also  in  the  country  that  the  most  primitive 
and  inadequate  toilet  accommodations  are  found,  yet 
it  is  this  which  should  receive  the  most  careful  atten- 
tion. There  should  be  a  separate  and  distinct  apart- 
ment for  each  sex,  and  the  construction  of  these  places 
should,  as  far  as  the  circumstances  permit,  conform 
to  modern  sanitary  requirements.  Special  care  in  this 
direction  is  one  of  the  most  effective  means  of  educat- 


HOME,  SCHOOL  AND  WORKSHOP  185 

ing  children  as  to  the  importance  of  proper  hygienic 
measures. 

There  is  no  place  where  personal  cleanliness  is  more 
urgently  demanded  or  where  its  importance  can  be 
more  conveniently  and  effectively  taught  than  in  the 
schoolhouse.  Contrary  to  the  general  belief,  disinfec- 
tants are  not  required  in  schools,  but  the  need  of  soap 
and  water  is  always  present.  It  is  not  true  that  germs 
are  everywhere  in  the  schoolroom  in  their  active  state 
ready  to  transmit  infection. 

Children  commonly  contract  measles,  diphtheria  and 
scarlet  fever  by  contact  with  those  who  have  these 
diseases,  commonly  in  a  mild  and  unrecognized  form, 
the  infectious  matter  being  contained  in  the  discharges 
from  the  nose,  throat  and  ears.  Infectious  matter  is 
conveyed  not  only  by  direct  contact  but  by  articles 
which  are  contaminated  with  the  discharges,  such  as 
common  drinking  cups  and  towels.  Therefore,  these 
should  be  replaced  by  individual  drinking  cups,  or 
drinking  water  should  be  supplied  by  an  apparatus 
which  does  not  permit  of  contamination.  Paper  towels 
should  be  supplied  instead  of  common  roller  and  other 
towels.  Furthermore,  the  exchange  of  partly  eaten 
food  or  fruit,  chewing-gum  and  other  articles  which 
are  transferred  from  the  mouth  of  one  to  another 
should  be  prevented. 

Hygiene  should  form  a  part  of  a  child's  earliest  in- 
struction. There  is  no  age  at  which  these  little  ones 
cannot  absorb  some  knowledge  of  the  principles  which 
govern  this  important  subject.  It  instils  into  their 
minds  the  value  of  at  least  some  of  the  hygienic  meas- 


i86  GOOD  HEALTH 

ures,  particularly  cleanliness,  and  has  a  more  lasting 
effect  than  when  this  education  comes  later  in  life. 
Unfortunately,  too  little  attention  is  given  to  the  mat- 
ter either  in  private  or  public  schools. 

It  is  not  difficult  to  appreciate  the  great  responsibil- 
ity which  rests  upon  school  teachers,  particularly  those 
in  country  places,  where  they  have  but  few  aids  in 
carrying  out  the  work  of  education.  The  fact  is  that 
they  are  largely  responsible,  not  only  for  the  book 
knowledge  of  children  and  for  their  manners,  but  also 
for  the  preservation  of  their  health.  Some  mothers, 
particularly  those  among  the  working  classes,  devote 
but  little  time  to  the  care  and  education  of  their  off- 
spring and  are  only  too  willing  to  shift  the  responsibil- 
ity to  the  shoulders  of  teachers,  whose  valuable  serv- 
ices are  not  fully  appreciated  and  whose  remuneration 
is  far  below  what  it  should  be,  particularly  in  the 
country. 

HYGIENE  OF  THE  WORKSHOP 

The  term  ''workshop,"  in  its  broadest  sense,  refers 
to  buildings  or  apartments  where  persons  are  engaged 
in  the  commercial  and  industrial  pursuits.  It  more 
commonly  applies  to  factories  where  many  employees 
are  brought  together  in  the  performance  of  their 
work.  Hygiene  of  the  workshop  relates  to  the  sani- 
tary arrangement  of  the  interior,  the  means  taken  by 
the  employers  to  guard  against  infectious  diseases  and 
the  personal  cleanliness  of  those  present. 

The  offensive  odors  noticeable  in  a  workroom  often 
come  from  unclean  skin  and  clothing  and  decayed 
teeth  of  those  present,  as  well  as  the  various  articles 


HOME,  SCHOOL  AND  WORKSHOP  187 

used  in  the  manufacture  of  goods.  It  will  thus  be  seen 
that  employers  are  not  entirely  responsible  for  insani- 
tary workrooms,  for  the  condition  of  these  places  de- 
pends largely  upon  the  personal  habits  of  the  em- 
ployees. 

An  employer  who  provides  a  sanitary  workshop, 
which  is  spacious,  attractive  and  well  lighted,  not  only 
renders  valuable  aid  in  preserving  the  health  of  his 
employees,  but  goes  far  to  teach  them  the  importance 
of  personal  hygiene.  Furthermore,  proper  care  of 
employees  is  of  substantial  economic  value  to  the  em- 
ployer, for  it  aids  in  maintaining  health  and  energy, 
and  yields  far  more  satisfactory  and  less  interrupted 
service. 

A  lavatory  properly  equipped  with  modern  sani- 
tary fixtures,  plenty  of  wash  basins,  a  good  supply 
of  soap  and  towels  and  a  sufficient  number  of  prop- 
erly constructed  waterclosets  is  also  a  very  effective 
means  of  impressing  employees  with  the  need  of  per- 
sonal cleanliness.  As  it  has  already  been  stated,  in- 
sufficient toilet  accommodations  interfere  very  serious- 
ly with  the  calls  of  nature,  and  this  irregularity,  when 
persisted  in,  is  detrimental  to  health. 

Any  towel  which  is  used  in  common  is  a  very  filthy 
and  insanitary  article  and  is  unfit  for  use  at  any  time. 
Diseases  may  be  transmitted  by  a  common  towel,  for 
infectious  material  is  conveyed  from  one  person  to  an- 
other through  the  medium  of  discharges,  which  easily 
contaminate  the  towel.  While  individual  linen  towels 
go  far  to  prevent  the  danger  referred  to,  they  are 
not  infrequently  lent  to  other  persons  and  are  not  al- 


1 88  GOOD  HEALTH 

ways  sent  to  the  laundry  as  often  as  they  should  be. 
The  risk  is  not  present  when  paper  towels  are  em- 
ployed, for  they  cannot  be  used  more  than  once.  With 
paper  towels  there  is  no  expense  for  washing  or  for 
the  loss  and  destruction  of  towels — not  a  small  item 
where  a  large  number  is  used.  It  is  true  the  cost  of 
laundering,  etc.,  may  be  equaled  by  the  cost  of  paper 
towels,  yet  the  fact  remains  that  the  advantage,  as  far 
as  cleanliness  and  the  prevention  of  disease  is  con- 
cerned, rests  with  the  latter. 

While  paper  towels  do  not  perform  all  the  functions 
of  an  ordinary  towel,  they  are  sufficient  for  the  work- 
shop or  office,  where  only  the  hands  and  face,  particu- 
larly the  former,  need  immediate  attention.  Paper 
towels  may  be  purchased  at  a  very  low  price,  from 
six  to  ten  for  a  cent,  depending  upon  the  material 
and  the  number  ordered.  A  good  serviceable  paper 
towel  acts  very  much  like  a  blotter.  It  should  be  care- 
fully pressed  against  the  skin  and  left  there  for  a 
moment  to  absorb  the  water,  then  gentle  friction 
should  be  used  with  the  dry  part  of  the  towel. 

Infectious  diseases  may  also  be  transmitted  from 
one  person  to  another  by  common  drinking  cups.  This 
may  be  prevented  by  the  use  of  receptacles  which 
remain  in  the  possession  of  the  owner,  or  still  better, 
paper  cups  which  are  destroyed  after  use.  Various 
forms  of  faucets  which  direct  a  stream  of  water  up- 
wards and  which  may  be  used  without  touching  the 
apparatus  with  the  mouth  are  also  of  practical  value 
in  the  prevention  of  disease. 

In  late  years  very  inviting  resting  rooms  have  been 


HOME,  SCHOOL  AND  WORKSHOP  189 

prepared  for  employees,  and  in  many  instances  lunch- 
eon is  provided  in  the  building.  While  to  a  certain 
extent  these  are  of  value,  they  are  not  in  full  accord 
with  the  principles  of  modern  health  methods.  Em- 
ployees whose  duties  are  of  sedentary  nature  often 
experience  a  sense  of  fatigue.  This  is  a  mental  and 
not  a  physical  condition  and  the  logical  remedy  for 
it  is  exercise  in  the  open  air  and  not  rest.  If  at  the 
noon  hour,  clerks,  typists,  operators,  etc.,  could  be 
induced  to  walk  or  take  some  mild  form  of  exercise 
in  the  open  air  for  half  an  hour  or  so  before  luncheon, 
it  would  be  far  more  valuable  than  rest,  although  at 
first  it  might  not  be  appreciated.  Moreover,  rest  rooms 
are  quite  apt  to  lead  to  slothful  habits. 

Lunch  rooms  provided  in  workshops  or  offices  are 
instituted  not  without  some. idea  of  profit  to  employ- 
ers ;  for  it  is  believed  that  by  this  means  less  time  will 
be  taken  for  the  noon  meal.  The  value  of  this  ar- 
rangement lies  chiefly  in  the  fact  that  good  food  may 
be  provided  at  a  minimum  cost.  On  the  other  hand, 
it  offers  no  encouragement  to  employees  to  seek  the 
benefits  of  outdoor  air  during  the  middle  of  the  day, 
which  is  refreshing  and  productive  of  better  service. 

From  the  standpoint  of  health,  it  would  be  far  bet- 
ter if  the  employers  who  contemplate  providing  lunch- 
eons for  their  employees,  either  free  or  at  a  minimum 
cost,  would  locate  the  lunch  room  some  distance  from 
the  shop  or  office,  thus  requiring  open  air  exercise  by 
the  employees  who  wish  to  secure  the  benefits  of  this 
arrangement. 

While  the  roof  of  a  building  may  be  used  for  an 


190  GOOD  HEALTH 

airing  and  for  certain  forms  of  exercise,  it  is  of  re- 
stricted value,  for  only  a  small  proportion  of  em- 
ployees can  or  will  take  advantage  of  this  means  of 
obtaining  fresh  air.  Exercise  in  the  form  of  walking 
is  particularly  beneficial  at  the  noon  hour,  for  it  bet- 
ter prepares  one  for  the  remaining  part  of  the  day's 
work. 

Every  employer  should  make  special  provision  to 
guard  his  employees  from  infectious  diseases.  Great 
aid  may  be  extended  in  this  direction  by  a  daily  vis- 
ual examination  of  employees  in  order  that  the  pres- 
ence of  eruptions  and  other  evidences  of  ill  health  may 
be  promptly  detected.  If  these  exist,  the  persons  af- 
fected should  be  directed  to  go  home,  seek  medical  ad- 
vice and  promptly  report  the  doctor's  opinion  in  the 
case.  This  will  enable  the  employer  to  take  such  ac- 
tion as  may  be  necessary  to  protect  employees  who 
have  been  exposed.  Many  outbreaks  of  disease  have 
been  prevented  in  this  way.  A  visual  examination  of 
the  employee  requires  little  time  on  the  part  of  the  em- 
ployer and  need  cause  no  annoyance  to  employees,  who 
indeed  need  not  even  know  that  an  examination  of  this 
kind  is  taking  place. 

Modern  sanitary  engineers  have  gone  far  towards 
perfecting  the  construction,  ventilation  and  lighting 
of  new  factories  and  apartments  where  many  em- 
ployees are  brought  together,  but  there  are  buildings 
in  use  which  are  old  and  of  imperfect  construction. 
It  is  the  latter  class  which  calls  for  the  most  careful 
attention  in  securing  at  least  reasonably  good  sanitary 
conditions. 


HOME,  SCHOOL  AND  WORKSHOP  191 

During  the  warm  weather,  electric  fans  properly 
placed  in  the  working  rooms  and  so  arranged  that  they 
are  not  unpleasantly  active  or  cause  too  rapid  evapora- 
tion from  the  skin,  contribute  much  to  the  comfort  of 
the  workers. 

The  ventilation  of  a  workshop  also  requires  special 
consideration  during  the  cold  weather,  for  the  win- 
dows and  doors  are  usually  kept  closed  and  the  apart- 
ments are  usually  overheated.  This  not  only  inter- 
feres with  ventilation,  but  renders  employees  more 
susceptible  to  colds  and  other  affections,  particularly 
if  manual  labor  is  being  performed.  This  subject 
has  already  been  dealt  with  in  the  chapter  on  Ven- 
tilation. The  general  principles  of  ventilation  hold 
true  whether  in  the  home  or  in  the  workshop. 


CHAPTER  XI 

BACTERIA,,    INFECTIOUS    DISEASES    AND    THE    MEANS    BY 
WHICH   THEY  ARE  TRANSMITTED 

BACTERIA 

Such  a  wealth  of  information  is  available  concern- 
ing bacteria  and  their  relation  to  'disease,  that  it  is 
only  proper  the  public  should  have  a  general  knowl- 
edge of  the  subject  in  order  that  more  advanced 
methods  may  be  followed  in  the  preservation  of  health. 

As  early  as  the  seventeenth  century,  various  inves- 
tigators had  observed,  with  the  aid  of  the  weak  and  im- 
perfect magnifying  glasses  of  that  period,  that  solids 
and  fluids  contained  very  small  living  bodies  which 
were  seen  to  move  about  in  the  field  of  vision.  As  the 
power  of  these  glasses  became  increased  through  more 
skillful  grinding,  still  smaller  objects  were  revealed, 
until  the  microscopes  of  today  are  able  to  detect  the 
most  minute  organisms,  some  of  which,  not  more  than 
1/50,000  of  an  inch  in  size,  are  brought  clearly  into 
view  and  easily  studied.  These  little  bodies,  or  mi- 
croorganisms, are  known  by  the  common  and  familiar 
name  of  bacteria  or  germs. 

Although  some  of  the  larger  of  these  bodies  were 
early  recognized,  they  remained  for  a  long  time  chiefly 
objects  of  curiosity  until  their  real  significance  was  ap- 

192 


INFECTION  193 

predated  and  they  were  carefully  studied  and  classi- 
fied. Within  the  past  quarter  of  a  century  rapid  strides 
have  been  made  in  this  direction.  Bacteriology,  which 
treats  of  this  subject,  plays  an  exceedingly  important 
part  in  the  prevention  and  cure  of  disease. 

Even  long  ago,  it  was  suggested  that  these  minute 
living  bodies  were  in  some  way  connected  with  the 
transmission  of  infection  from  one  person  to  another^ 
although  comparatively  little  definite  published  knowl- 
edge was  obtained  on  the  subject  until  about  1880, 
when  Pasteur  and  Koch,  respectively  French  and  Ger- 
man bacteriologists,  working  independently  of  each 
other,  presented  to  the  world  conclusive  evidence  of 
the  germ  origin  of  disease.  Since  that  period,  labora- 
tories throughout  the  world  have  been  engaged  in  the 
most  important  and  exhaustive  investigations  in  this, 
field. 

Bacteria  are  arranged  in  groups  or  classes,  and  the 
characteristics  of  each  individual  organism  are  care- 
fully studied  as  well  as  the  conditions  under  which  it 
thrives  best  and  the  agents  which  are  destructive  to  it. 

Bacteria,  or  germs,  are  divided  according  to  their 
shape  into  three  groups.  Those  which  are  round  are 
known  as  cocci;  those  which  are  long  or  rod-shaped  as 
bacilli;  and  the  curved  or  spiral  ones  are  called  spirilla. 
These  groups  do  not  change  from  one  shape  to  an- 
other, although  the  individuals  of  the  different  groups 
have  certain  peculiarities  by  which  they  may  be  distin- 
guished from  others  of  the  same  group.  Bacteriolo- 
gists must  be  familiar  with  these  conditions  in  order 
to  recognize  the  various  germs  which  cause  disease. 


194  GOOD  HEALTH 

For  instance,  the  round  bacteria,  or  cocci,  are  found 
in  pneumonia  and  meningitis ;  the  long  or  rod-shaped 
bacteria,  or  bacilli,  are  present  in  typhoid  fever  and  tu- 
berculosis ;  and  the  curved  or  twisted  bacteria,  known 
as  spirilla,  appear  in  cholera.  While  it  is  often  difficult 
to  separate  and  identify  the  various  germs  of  each 
group,  continued  increase  in  the  power  of  the  micro- 
scope and  more  effective  means  of  staining  the  germs, in 
order  that  they  may  be  more  easily  detected,  and  the 
specific  serum  tests  have  accomplished  much  in  remov- 
ing difficulties  connected  with  this  work.  This  is  ex- 
ceedingly important,  for  the  identification  of  many  dis- 
eases now  depends  almost  entirely  upon  bacteriological 
examination.  It  is  believed  that  largely  through  aid 
obtained  in  this  way  some  of  the  infectious  diseases 
will  be  eliminated. 

Very  valuable  information  has  been  acquired  re- 
garding what  takes  place  after  the  germs  enter  the 
body,  particularly  as  to  the  manner  in  which  they 
cause  diseases  and  what  becomes  of  them.  When  we 
consider  the  organisms  which  may  gain  entrance  into 
the  system  and  the  rapidity  with  which  they  multiply, 
in  some  instances  doubling  in  number  about  every 
twenty  minutes,  it  is  hard  to  understand  how  we  es- 
cape serious  results  after  infection  has  once  taken 
place. 

In  recent  years  definite  knowledge  relating  to  this 
part  of  the  subject  has  been  secured,  and  quite  clearly 
shows  the  manner  in  which  the  body  protects  itself 
against  this  danger.  While  this  is  not  by  any  means  al- 
ways sufficient  to  prevent  a  fatal  result  in  the  various 


INFECTION  195 

forms  of  infection  which  attack  the  human  body,  the 
fact  that  recovery  so  commonly  ensues  is  due  largely 
to  this  means  of  protection. 

In  the  blood  are  found  microscopic  bodies  known  as 
leukocytes,  or  white  blood  corpuscles,  the  function 
of  which  for  a  long  time  was  in  doubt.  Now  it  is 
known  that  in  addition  to  whatever  else  they  may  do, 
they  are  germ  destroyers;  and  under  the  microscope, 
the  leukocytes  may  be  seen  drawing  the  germs  within 
themselves  for  destruction.  After  a  while  the  body  re- 
acts to  the  germs  and  the  blood  acquires  a  germicidal 
power. 

It  is  not  the  mere  presence  of  bacteria  within  the  body 
which  is  responsible  for  the  danger  which  may  follow 
an  invasion  of  this  kind,  but  more  directly  the  fact  that 
these  organisms  give  off  a  poisonous  product  known  as 
toxin.  The  presence  of  this  poison  in  the  body  stimu- 
lates and  causes  the  blood  to  produce  a  protective  agent 
or  antagonist,  known  as  antitoxin,  also  antibodies,  to 
neutralize  the  toxin.  Therefore  both  the  blood  and  the 
leukocytes  which  it  contains  are  powerful  agents  of  de- 
fense against  the  bacteria  and  their  poison. 

It  was  the  belief  of  bacteriologists  who  early  studied 
this  subject  that  if  antitoxin  or  germicidal  serum  could 
be  prepared  in  large  quantities  outside  the  human 
body,  and  promptly  introduced  into  the  system  when 
infection  occurs  to  aid  the  antitoxin  already  formed  in 
the  blood  of  the  person  affected,  it  would  go  far  to 
render  the  disease  mild ;  or  if  injected  into  the  body  of 
those  who  have  been  exposed,  it  would  probably  ren- 
der them  immune  or  prevent  the  appearance  of  the 


196  GOOD  HEALTH 

disease.  In  the  investigation  of  this  subject  it  was 
found  that  some  animals,  particularly  the  horse,  pro- 
duce large  quantities  of  antibodies  and  are  not  suscep- 
tible to  the  action  of  infectious  germs,  which  are  dan- 
gerous to  human  beings. 

This  formed  the  basis  of  a  most  exhaustive  series 
of  experiments  which  demonstrated  the  fact  that  if 
germs  of  certain  diseases,  or  rather  the  poison  they 
generate  (toxins),  is  injected  into  the  circulation  of 
the  horse  it  is  followed  by  the  production  of  antitoxin 
or  germicidal  substance  in  large  quantities.  In  order 
to  obtain  this  for  use  in  the  human  being  the  blood  is 
withdrawn  from  the  horse  by  opening  a  vein  and  the 
fluid  portion  or  serum  which  contains  the  antitoxin  or 
antibodies  is  afterwards  separated,  or  decanted.  This 
product  is  then  bottled  and  sealed  and  ready  for  dis- 
tribution, great  care  being  taken  to  prevent  outside 
contamination.  The  use  of  this  is  known  as  the  anti- 
toxin treatment. 

As  each  form  of  bacteria  produces  its  own  peculiar 
poison,  it  naturally  follows  that  a  special  antitoxin  is 
necessary  for  each  disease.  For  instance,  to  secure  a 
diphtheria  antitoxin,  horses  are  injected  with  the  diph- 
theria toxin. 

The  diphtheria  antitoxin  has  probably  proved  the 
most  successful  of  all  in  connection  with  this  form  of 
treatment,  and  its  use  is  indicated  not  only  in  cases  of 
this  disease,  but  also  as  a  preventive  measure.  Teta- 
nus, or  lockjaw,  antitoxin  has  also  proven  extremely 
valuable  in  the  prevention  of  lockjaw.  Other  protec- 
tive sera  have  been  prepared  and  are  in  use. 


INFECTION  197 

Serum  and  vaccine  treatment  differ  in  this  way.  In 
the  serum  method  the  fluid  portion  of  the  blood  of  an 
immunized  horse,  already  referred  to,  is  injected  into 
the  human  body,  while  the  vaccine  treatment  consists 
either  in  injecting  under  the  skin  or  rubbing  into  its 
scarified  surface  dead  or  living  organisms  of  certain 
diseases.  If  the  living  organisms  are  used,  they  are 
first  rendered  unable  to  do  any  active  danger  them- 
selves, and  in  either  instance,  it  is  the  poison  given 
off  from  the  germs  which  is  expected  to  stimulate 
the  cells  of  the  body  to  furnish  antibodies  that  will 
give  immunity  against  the  disease  in  question.  While 
these  forms  of  treatment  affect  the  system,  sometimes 
very  actively,  the  effect  is  transient  and  comparatively 
trivial  compared  with  the  effects  of  the  disease  which 
the  vaccine  is  given  to  prevent. 

Vaccination  for  the  prevention  of  smallpox  is  a  very 
peculiar  example  of  one  form  of  treatment.  In  this 
method  the  arm  or  leg  is  scarified  and  the  vaccine  mat- 
ter rubbed  into  the  skin  to  be  quickly  absorbed.  In 
antityphoid  vaccination  the  organisms  are  injected  un- 
der the  skin. 

Bacteriologists  have  found  that  under  some  condi- 
tions vaccines  work  more  effectively  as  immunizing 
agents  than  sera,  and  vice  versa.  Therefore  both  are 
employed.  The  final  word  has  not  been  said  regarding 
their  degree  of  efficiency  nor  the  unpleasant  results 
which  may  follow  this  treatment  if  not  committed  to- 
the  hands  of  those  skilled  in  its  use. 

It  is  important  that  the  public  should  know  some- 
thing of  the  antitoxin  and  vaccine  treatment,  but  it 


198  GOOD  HEALTH 

should  be  warned  against  the  employment  of  these 
agents  by  unscrupulous  and  incompetent  persons  who 
often  suggest  this  form  of  treatment  in  order  to  make 
use  of  worthless  and  dangerous  products.  This  is  par- 
ticularly true  in  connection  with  tuberculosis.  There  is 
no  germicidal  serum,  antitoxin  or  vaccine  yet  produced 
which  is  of  very  real  practical  value  in  the  treatment  of 
tuberculosis,  and  any  agent  advertised  for  this  pur- 
pose should  be  carefully  avoided.  Besides,  no  form  of 
antitoxin  treatment  should  be  allowed  except  upon  the 
recommendation  of  some  reputable  physician  who  is 
competent  to  decide  when  this  remedy  is  indicated  and 
where  a  proper  supply  can  be  obtained. 

While  the  value  of  the  means  of  defense  above  re- 
ferred to  cannot  be  overestimated,  there  is  a  more  im- 
portant factor  in  guarding  against  the  danger  of  in- 
fectious disease,  and  that  is  good  health.  Conclusive 
evidence  has  been  presented  that  not  only  are  bacteria 
upon  entering  the  system  far  more  dangerous  when 
the  resisting  power  of  the  body  is  low,  but  at  such 
times  the  antitoxin-forming  function  of  the  blood  is  far 
less  effective.  Therefore,  preparation  to  meet  the  dan- 
ger is  largely  in  our  own  hands,  for  by  carefully  con- 
forming to  the  rules  of  personal  hygiene,  we  may  go 
far  to  avert  the  attacks  of  infectious  diseases. 

The  above  account  of  bacteria  appHes  chiefly  to 
pathogenic  organisms,  that  is,  germs  which  produce 
infectious  diseases,  but  the  far  greater  number  of  bac- 
teria— and  it  is  those  with  which  we  are  in  more  or  less 
constant  contact — are  not  of  this  order.  They  are  as  a 
rule  harmless,  or  in  some  instances  very  necessary  to 


INFECTION  199 

our  well  being  and  aid  in  our  protection.  For  instance, 
some  of  them  are  exceedingly  active  in  the  destruction 
of  dead  and  putrefying  material. 

These  forms  of  bacteria  may  be  found  on  our  body, 
clothing,  money  and  wherever  there  is  exposure.  They 
do  not  transmit  disease,  although  the  public  are  made 
apprehensive  regarding  their  presence.  It  is  sufficient 
to  know  that  they  are  not  the  menace  they  are  believed 
to  be.  This  form  of  bacteria  will  again  be  referred  to 
in  the  following  section. 

INFECTIOUS    DISEASES   AND    THE    MEANS   BY 
WHICH   THEY  ARE  TRANSMITTED 

No  subject  touching  upon  the  protection  of  health 
has  received  more  exhaustive  investigation  than  that 
relating  to  the  means  by  which  infectious  diseases  are 
transmitted  from  one  person  to  another.  Certain  the- 
ories connected  with  this  subject,  which  have  been  long 
and  universally  accepted,  are  now  known  to  be  largely 
erroneous.  The  most  notable  of  these  is  the  so-called 
**fomites"  theory,  which  holds  that  clothing,  baggage, 
cargoes  of  vessels,  various  textile  fabrics,  money,  etc., 
transmit  pathogenic  or  disease-producing  organisms 
from  one  person  to  another.  The  truth  is  that  these 
articles  are  not  media  of  infection  except  in  rare  in- 
stances. 

While  the  fomites  theory  has  until  recent  years  been 
generally  accepted,  there  is  little  scientific  evidence  to 
sustain  it,  and  its  chief  support  lies  in  the  fact  that  it 
offers  a  plausible  explanation  for  outbreaks  of  infec- 
tious disease,  the  origin  of  which  is  unknown  or  at 


200  GOOD  HEALTH 

the  time  cannot  be  explained.  The  presence  of  this 
belief  inspires  the  fear  that  sources  of  infection  exist 
almost  everywhere. 

The  supposed  danger  according  to  the  f  omites  theory 
is  responsible  for  many  unnecessary  and  ridiculous 
practices.  For  instance,  a  person  will  grasp  a  car  strap 
very  cautiously  for  fear  of  contracting  disease,  and  yet 
he  will  handle  without  a  qualm  the  handrail  of  a  pub- 
lic stairway  and  various  other  exposed  surfaces  which 
may  be  contaminated  with  the  same  forms  of  bac- 
teria. It  is  true  that  these  exposed  surfaces  harbor 
many  germs,  but  as  a  rule  they  are  harmless  and  exist 
everywhere,  and  will  be  found  on  our  hands,  the  linen 
we  wear,  etc.  While  it  is  possible  that  in  some  in- 
stances pathogenic  organisms  are  present,  the  danger 
of  their  transmitting  disease  is  very  remote  and  need 
cause  no  apprehension.  For  when  these  organisms  are 
deposited  upon  clothing  or  other  articles  they  probably 
become  inactive  from  exposure ;  besides,  they  are  sep- 
arated from  the  substance  which  provides  them  with 
nourishment.  Frequent  cleansing  of  the  hands  will  go 
far  to  prevent  any  possible  infection  from  this  direc- 
tion. 

Old  and  filthy  money  is  popularly  looked  upon  as  a 
fruitful  source  of  infection.  There  is  really  nothing  to 
substantiate  this  belief.  While  it  is  desirable  that  old 
paper  money  be  removed  from  circulation  and  new 
bills  substituted,  it  should  be  understood  that  it  is  for 
appearance's  sake  and  not  because  of  danger  of  in- 
fection. 

It  is  still  believed  by  many  that  infection  is  trans- 


INFECTION  201 

mitted  over  long  distances  through  the  air,  even  a  mile 
or  more  (aerial  infection).  There  is  not  only  no  sci- 
entific authority  for  this,  but  the  proposition  that  dis- 
eases are  transmitted  in  this  way,  except  in  the  imme- 
diate vicinity  of  the  source  of  infection,  is  not  entitled 
to  respectful  consideration.  There  are  many  other 
popular  notions  of  this  kind  which  have  long  been  cher- 
ished, but  in  recent  years  these  have  also  been  proved 
to  be  without  support. 

What,  then,  are  the  true  means  of  infection?  For- 
tunately, we  now  have  very  extended  and  definite  in- 
formation on  the  subject.  Infectious  diseases  are 
usually  transmitted  ( i )  directly  from  one  person  to  an- 
other through  the  medium  of  discharges  from  the  body 
which  contain  infectious  germs  or  organisms  in  their 
active  state ;  (2)  indirectly  through  the  medium  of 
contaminated  food  and  drink,  and  (3)  by  certain  biting 
insects,  mosquitoes,  for  example,  which  in  the  manner 
of  their  kind,  transmit  infectious  agents  from  one  per- 
son to  another. 

If  all  cases  of  infectious  diseases  were  well  marked 
and  could  be  promptly  and  easily  identified,  the  danger 
of  their  spread  would  be  greatly  diminished,  for  we 
could  then  better  guard  against  infective  discharges; 
but  unfortunately,  these  diseases  very  often  appear  in  a 
mild,  irregular  and  unrecognized  form,  and  are  over- 
looked or  mistaken  for  some  simple  malady  and  usually 
treated  with  home  remedies. 

Another  very  common  and  dangerous  source  of  in- 
fection, and  one  which  is  now  becoming  more  fully 
recognized,  is  what  are  known  as  "carriers,"  that  is, 


202  GOOD  HEALTH 

persons  who  retain  actively  infectious  organisms  within 
their  body  and  who  themselves  are  apparently  well,  yet 
through  the  medium  of  infectious  discharges  may 
transmit  disease  to  others.  This  very  frequently  occurs 
in  connection  with  typhoid  fever. 

Certain  insects  transmit  infection.  We  have  indis- 
putable evidence  that  malarial  and  yellow  fever  are 
conveyed  from  one  person  to  another  by  the  bite  of 
certain  infected  mosquitoes,  and  as  far  as  we  know  at 
the  present  time,  there  are  no  other  means  by  which 
these  diseases  are  communicated.  The  fly  is  also  re- 
garded as  a  medium  of  infection.  The  flea  that  infests 
the  rat  transmits  the  infection  of  bubonic  plague,  and 
it  has  recently  been  shown  that  the  body  louse  proba- 
bly carries  the  germ  of  typhus  fever  from  one  person 
to  another. 

Filth  does  not  cause  infectious  diseases,  but  disease 
thrives  best  where  there  is  filth,  overcrowding  and  bad 
air.  To  illustrate :  During  the  outbreak  of  typhus 
fever  which  occurred  in  New  York  in  the  winter  of 
1893-4,  over  seven  hundred  cases  were  discovered,  and 
all  but  two  or  three  of  them  were  found  among  the  ten- 
ement and  lodging  house  population  where  uncleanli- 
ness,  lice  and  overcrowding  were  rife. 

The  prompt  detection  of  an  infectious  disease  is 
vitally  important,  for  this  not  only  offers  better  chance 
for  recovery  for  those  who  are  ill,  but  goes  far  to  pre- 
vent the  spread  of  infection.  Unfortunately,  tubercu- 
losis, which  exists  almost  everywhere,  frequently 
reaches  an  advanced  stage  before  its  character  is 
known,  and  little  can  be  done  for  the  patient;  mean- 


INFECTION  203 

while  infective  matter  has  been  slowly  distributed. 
Smallpox  often  appears  in  a  mild  form,  and  not  ttn- 
f requently  is  mistaken  for  a  condition  which  is  not  in- 
fectious. Through  such  errors,  serious  outbreaks  may 
follow. 

Diphtheria,  measles  and  scarlet  fever,  which  are 
more  or  less  constantly  present,  are  frequently  unrec- 
ognized. There  is  no  doubt  that  the  increased  number 
of  cases  which  occur  at  the  beginning  of  the  school 
year  is  due  largely  to  the  transmission  of  discharges 
from  mild  and  undetected  cases,  and  not  from  infected 
clothing,  as  was  formerly  supposed. 

In  tuberculosis  it  is  the  sputum  or  expectoration 
which  contains  the  infectious  organisms.  Through 
sprays  or  droplets  thrown  off  from  the  respiratory 
tract  and  in  other  ways,  largely  through  uncleanliness, 
the  organisms  are  transmitted  from  one  person  to  an- 
other, the  more  readily  where  insanitary  conditions  ex- 
ist, for  then  less  care  is  taken  to  guard  against  the 
danger. 


CHAPTER  XII 

MOSQUITOES  AND  FLIES  AND  THEIR   EXTERMINATION 

The  extermination  of  mosquitoes  is  a  very  impor- 
tant factor  in  the  preservation  of  health,  not  only  be- 
cause they  constitute  a  source  of  annoyance,  but  far 
more  serious,  because  they  transmit  infectious  germs 
from  one  person  to  another.  Their  elimination  cannot 
be  successfully  accomplished  unless  there  is  proper 
widespread  cooperation  between  the  public  and  mu- 
nicipal and  state  authorities.  For  this  reason  it  is  nec- 
essary that  we  should  know  something  of  the  habits  of 
these  insects  and  the  manner  in  which  they  live  and 
breed. 

During  the  early  part  of  the  last  century  it  was  sug- 
gested that  in  some  way  insects  might  act  as  a  media 
of  infection.  However,  the  limited  resources  of  bac- 
teriology at  this  time,  as  well  as  other  conditions,  dis- 
couraged the  thorough  investigation  of  this  subject. 
Little  was  done  in  this  direction  until  1880,  when  Dr. 
Laveran,  a  French  army  surgeon  on  duty  in  Algiers, 
found  in  the  blood  of  malarial  cases  under  his  care  a 
germ  or  organism  which  he  believed  to  be  the  cause  of 
this  disease.  He  announced  his  discovery  to  the  Paris 
Academy  of  Medicine  and  his  statements  were  after- 
ward confirmed  by  other  investigators. 

204 


MOSQUITOES  AND  FLIES 


205 


Then  the  question  arose  as  to  the  means  by  which 
these  organisms  are  introduced  into  the  human  body. 


Fig.  19. — The  mosquito:  female.  While  the  antennse  of  the  female 
have  hairlike  processes  (see  above),  the  antennae  of  the  male 
consist  of  well  marked  and  easily  recognized  plumes. 


This  led  to  extended  research  which  after  some  time 
resulted  in  the  discovery  that  the  infectious  organisms 
of  malaria  are  transmitted  from  one  person  to  another 
by  a  variety  of  mosquitoes  known  as  the  ''Anopheles." 


2o6  GOOD  HEALTH 

So  far  as  we  know  at  present  there  is  no  other  way  by 
which  this  disease  can  be  communicated. 

Following  this  important  discovery,  further  evidence 
concerning  the  danger  of  the  mosquito  as  a  medium  of 
infection  was  presented.  This  occurred  during  the  oc- 
cupation of  Cuba  by  the  United  States  Government 
in  1900.  At  that  time  a  commission  composed  of 
medical  officers  of  the  Army  was  appointed  by  the 
President  for  the  purpose  of  identifying,  if  possible, 
the  germ  of  yellow  fever,  and  the  means  by  which  it 
was  transmitted.  While  the  germ  of  this  disease  has 
not  been  found,  the  Commission  was  able  to  present 
indisputable  evidence  that  whatever  it  may  be  it  is 
transmitted  from  one  person  to  another  by  the  mos- 
quito ;  and  as  in  the  case  of  malaria  it  is  believed  that 
there  is  no  other  medium  of  infection.  The  variety  of 
the  mosquito  which  transmits  yellow  fever  is  known 
as  the  **Aedes"  or  "Stegomyia." 

It  has  been  proved,  therefore,  that  the  infectious 
organisms  of  two  diseases  which  cause  great  suffering 
and  loss  of  life  throughout  the  world,  are  transmitted 
by  mosquitoes.  More  recently  it  has  been  found  that 
other  diseases  are  also  conveyed  from  one  person  to 
another  by  these  insects.  We  are  not  yet  aware  to 
what  extent  infection  may  be  conveyed  in  this  manner. 
It  is  sufficient  to  know  that  mosquitoes  constitute  a 
dangerous  menace  to  health.  It  may  be  added  that 
the  Anopheles  and  the  Stegomyia  transmit  diseases 
only  when  they  are  carriers  of  the  infectious  organ- 
isms. At  other  times  they  are  no  more  harmful  than 
the  more  common  or  ordinary  mosquitoes. 


MOSQUITOES  AND  FLIES  207 

Mosquitoes  propagate  only  in  water,  upon  the  sur- 
face of  which  they  deposit  their  eggs  in  large  numbers, 
usually  two  or  three  hundred  at  a  time.  Within  twen- 
ty-four hours  afterward,  hatching  takes  place  and  the 
larvae  appear.  These  little  bodies,  which  can  live  only 
in  water,  are  commonly  known  as  "wigglers,"  and 
when  full  grown  are  about  a  quarter  of  an  inch  long. 
At  first  they  are  so  small  that  they  are  not  usually  de- 
tected by  the  naked  eye  except  by  those  familiar  with 


Fig.  20. — Manner  in  which  the  eggs  of  the  Culex  pipiens,  or  com- 
mon house  mosquito,  are  deposited.     (Howard.) 


their  propagation;  after  two  or  three  days  they  are 
easily  recognized. 

A  very  simple  and  interesting  way  of  studying  the 
habits  of  the  larvae  consists  in  placing  the  water  which 
contains  them  in  a  glass  in  front  of  a  light.  On  look- 
ing through  the  glass  the  larvae  will  be  seen  moving 
about  in  the  water  in  a  rapid  and  jerky  way.  It  is  in- 
teresting to  note  that  while  the  larvae  cannot  live  out 
of  the  water  they  must  have  air;  therefore,  every  min- 
ute or  so  their  tails  are  projected  above  the  surface,  for 
this  extremity  contains  the  minute  opening  of  the  res- 
piratory apparatus.  Thus  it  may  be  said  that  the 
larvae  breathe  through  the  tail. 

After  a  period  of  six  or  eight  days,  the  head  of  the 


2o8  GOOD  HEALTH 

larva  becomes  enormously  enlarged,  resembling  a 
comma  in  appearance.  This  is  known  as  the  "pupal" 
stage  and  lasts  about  two  days,  terminating  in  the  birth 
of  the  winged  insect.  A  pupa  is  inactive  except  when 
frightened,  and  lies  close  to  the  surface  of  the  water, 
requiring  little  or  no  food. 


Fig.  21. — Eggs  of  the  Anopheles.  (Howard.)  Those  of  the  Steg- 
omyia  and  some  other  varieties  of  the  inland  mosquito  and  also 
the  Culex  sollicitans  are  laid  similarly  to  these. 

If  the  observer  has  the  time  and  patience  to  watch 
a  pupa  carefully  for  a  day  or  so,  it  will  be  seen  to  rise 
to  the  surface  of  the  water  for  the  last  time.  Grad- 
ually the  envelope  or  covering  which  surrounds  it  is 
broken  and  the  full  grown  mosquito  appears.  It  hesi- 
tates for  a  moment,  resting  on  the  envelope  or  shell  to 
get  its  bearing,  and  then  flies  away. 


MOSQUITOES  AND  FLIES 


209 


While  there  are  many  varieties  of  mosquitoes,  it 
will  be  sufficient  to  refer  to  the  more  common  ones, 
particularly  those  which  are  found  in  this  country. 
Two  classes  may  be  described :  the  inland  mosquito 
and  the  Atlantic  Coast  mosquito,  also  known  as  the 


Fig.  22. — The  mosquito   larva. 


"salt  water  swamp"  or  ''striped-legged"  mosquito. 
The  most  common  inland  mosquito,  the  Culex  pi- 
piens,  which  is  found  throughout  the  world,  is  fre- 
quently called  the  house  or  rain  barrel  mosquito,  and  it 
is  the  one  usually  found  indoors.  It  is  of  medium  size 
with  a  rather  thin  body,  its  color  ranging  from  a  deep 
yellow  to  a  dark  brown,  with  legs  of  practically  the 
same  shade.  It  has  no  marking  on  the  back  or  feet. 
The  Anopheles,  or  malarial,  mosquito  is  a  variety  of 


210 


GOOD  HEALTH 


Pig.  23. — Position  of  larva  of  common  mosquito  in  obtaining  air. 

(Howard.) 

the  inland  mosquito.  If  carefully  examined  it  will  be 
found  to  have  wings  which  are  mottled  or  spotted  with 
brown  or  black.     When  at  rest  its  body  is  almost  at 


~T 


Fig.  24. — Position  of  Anopheles  larva  in  obtaining  air.     (Howard.) 


MOSQUITOES  AND  FLIES  211 

right  angles  with  the  surface  upon  which  it  rests,  while: 
the  body  of  the  Culex  pipiens  is  parallel  to  it. 

The  Aedes,  or  Stegomyia,  or  yellow-fever,  mosquito- 
is  also  a  variety  of  the  inland  mosquito,  and  is  found 
principally  in  the  West  Indies,  South  America,  Mexico, 
and  the  southern  part  of  the  United  States.  It  has  the: 
reputation  of  being  in  appearance  the  most  attractive 
of  all  mosquitoes.    It  is  comparatively  small,  with  bril- 


FiG.  25. — Pupa.      (Smith.) 

liant  yellowish  stripes  across  its  abdomen,  thorax  and' 
legs.  On  the  legs  the  stripes  are  not  so  pronounced 
as  in  the  case  of  the  ''striped-legged"  or  Atlantic  Coast 
mosquito,  and  it  has  no  transverse  stripes  on  its  beak — 
the  reed-like  process  extending  from  the  head — which 
is  found  in  the  latter  variety.  Both  the  Anopheles  and 
the  Stegomyia  are  house  mosquitoes  and  usually  re- 
main quite  close  to  their  breeding  places. 

The  Sollicitans,  or  Atlantic  Coast,  mosquito  is  not  so 
often  found  within  the  house,  but  usually  makes  its  at- 
tack outside.  It  is  easily  recognized  with  the  naked 
eye  by  broad  white  or  light-colored  stripes  on  its  legs; 


212  GOOD  HEALTH 

and  one  in  the  middle  of  the  beak,  the  latter  offering 
the  most  important  means  of  identification.  This  mos- 
quito breeds  in  the  salt  marshes  along  the  Atlantic 
Coast,  and  has  also  received  the  name  of  striped-legged 
or  salt  marsh  mosquito.  It  propagates  in  such  large 
numbers  that  some  coast  towns  are  almost  uninhab- 
itable. 

It  was  formerly  believed  that  all  varieties  of  mos- 


FiG.  26. — Culex  pipiens,  or  common  house  mosquito,  female. 

(Howard.) 

quitoes  breed  wherever  water  can  be  found.  Now  we 
know  that  the  inland  mosquito  does  not  breed  in  salt 
water  swamps  and  that  the  striped-legged  mosquito 
does  not  breed  inland.  This  knowledge  is  of  great 
practical  value  in  the  extermination  of  these  insects. 

The  breeding  places  of  the  inland  varieties  of  mos- 
quitoes are  so  numerous  that  they  often  escape  detec- 


MOSQUITOES  AND  FLIES  '213 

tion  even  by  those  who  are  making  careful  search  for 
them.  For  this  reason  the  work  of  extermination  is 
often  difficult.  Common  breeding  places  are  excava- 
tions, old  tin,  crockery  and  glassware,  cesspools,  drains, 
water  troughs,  rain  barrels,  cisterns,  broken  roof  lead- 


FiG.  2^. — Anopheles,  or  malarial  mosquito,  female.     (Howard.) 

ers,  and  the  like.  Mosquitoes  also  breed  in  urns  in 
cemeteries,  statuary  in  parks,  excavations  for  new 
buildings,  street  sewers,  water  tanks,  etc. 

Contrary  to  the  general  belief,  mosquitoes  do  not 
breed  in  large  bodies  of  water,  except  where  it  is  par- 
ticularly rich  in  organic  matter,  in  which  cases  they 


:2I4  GOOD  HEALTH 

l^reed  along  their  edges  in  small  pools.  They  prefer 
small  collections  of  water  containing  rich  vegetation 
where  they  are  quiet  and  better  protected.  While 
some  varieties  of  inland  mosquitoes  may  be  satisfied 
with  clean  water  for  breeding  purposes,  the  more  com- 
mon types  choose  that  which  is  contaminated  and 
filthy,  as  it  contains  more  nourishment  for  the  larvae 
in  the  shape  of  decomposed  organic  matter.  There- 
fore, the  additional  danger  of  filthy  and  stagnant  water 
IS  evident. 

As  already  stated,  the  Atlantic  Coast  mosquito  breeds 
in  salt  or  brackish  water  but  not  inland.  Those  who 
liave  not  seen  the  great  swamps  along  the  Atlantic 
Coast  can  form  no  adequate  idea  of  the  enormous 
l)reeding  places  they  supply  in  the  shape  of  surface  de- 
pressions, which  are  more  or  less  constantly  covered 
with  water  from  the  incoming  tide. 

Mosquitoes  live  on  plants,  fruits,  etc.,  although  the 
females,  the  only  ones  which  bite,  crave  blood,  as 
those  living  in  mosquito  infested  districts  will  testify. 

The  larvae  are  voracious  eaters  and  move  rapidly 
about  in  the  water  in  quest  of  food.  Probably  little 
or  no  nourishment  is  required  during  the  pupal  stage, 
for,  as  above  explained,  this  is  preliminary  to  the  ap- 
pearance of  the  winged  insect. 

It  is  commonly  believed  that  mosquitoes  live  only 
■one  day.  There  is  no  warrant  for  this  belief,  and  al- 
though it  is  difficult  to  fix  definitely  their  life  cycle,  it 
may  be  said  that  the  females  probably  live  about  two 
or  three  weeks  and  the  males  a  few  days  only. 

Perhaps  no  question  concerning  the  habits  of  mos- 


MOSQUITOES  AND  FLIES  215 

quitoes  has  been  more  widely  discussed  than  the  dis- 
tance which  they  travel  from  their  homes  or  breeding 
places.  The  inland  mosquito  is  not  voluntarily  a  mi- 
gratory insect,  but  usually  remains  near  its  breeding 


Fig.  28. — Stegomyia,  or  yellow  fever  mosquito,  female.     (Howard.) 


place  unless  driven  away  by  winds,  smoke,  etc.  This 
knowledge  is  of  great  practical  value  in  the  extermina- 
tion of  this  variety,  for  if  it  is  found  in  large  numbers 
at  a  given  place  it  may  be  safely  assumed  that  the 
breeding  place  is  not  far  away.  This  must  not  be  relied 
upon  too  implicitly,  however,  for  inland  mosquitoes 
may  travel  further  than  we  believe. 

The  Atlantic  Coast,  or  striped-legged,  mosquito  is 


2i5  GOOD  HEALTH 

notoriously  a  roaming  insect,  for  it  is  commonly  found 
miles  from  home.  It  is  believed  that  these  journeys 
are  voluntary  and  in  quest  of  food  best  suited  for  its 
use,  which  is  apparently  found  only  in  salt  water 
swamps. 

The  sudden  appearance  of  a  large  number  of  mos- 
quitoes suggests  that  they  have  been  brought  from  a 
distance  by  winds,  and  if  the  direction  of  the  wind  is 
ascertained,  some  information  may  be  obtained  as  to 
the  location  of  breeding  places.  There  is  no  doubt 
that  mosquitoes  are  carried  from  one  place  to  another, 
probably  over  long  distances,  by  modern  means  of 
travel.  This  may  explain  the  appearance  of  these  in- 
sects in  certain  sections  of  the  country  which  hereto- 
fore were  free  from  them. 

Mosquitoes  are  particularly  active  at  night.  It  is 
then  they  breed  and  bite  more  fiercely.  During  the 
day  they  collect  in  tall  grass,  bushes,  etc.,  evidently  to 
rest  and  escape  from  the  light  and  heat  and  to  find 
protection  during  rainstorms.  Therefore  the  impor- 
tance of  removing  this  growth,  whenever  it  is  practi- 
cable to  do  so,  is  manifest. 

The  question  is  very  naturally  asked :  By  what 
means  do  mosquitoes  perpetuate  their  species  from  one 
season  to  another?  Some  varieties,  the  yellow-fever 
mosquito,  for  example,  which  are  found  in  tropical  or 
very  warm  countries,  propagate  more  or  less  through- 
out the  entire  year;  while  in  sections  where  there  are 
decided  climatic  changes,  as  in  the  middle  or  more 
northerly  parts  of  the  country,  or  wherever  the  tem- 
perature remains  below  70°  F.  for  an  extended  period, 


MOSQUITOES  AND  FLIES  217 

propagation  ceases  and  most  of  them  die.  Some  of 
the  females,  however,  seek  protected  places,  pass 
through  the  cold  weather  in  a  state  of  torpor,  known  as 
''hibernation,"  until  springtime,  when  they  become  ac- 
tive again,  seek  a  new  breeding  place,  lay  their  eggs 
and  die.  This  teaches  an  exceedingly  important  lesson 
that  should  be  remembered ;  that  is,  if  breeding  places 
are  destroyed  early  in  the  season,  and  the  hibernating 
females  do  not  find  a  place  to  deposit  their  eggs,  there 
will  be  during  the  following  months  no  mosquitoes  ex- 
cept the  immigrating  insects.  The  work  of  mosquito 
extermination,  therefore,  should  begin  very  early  in 
the  year,  and  an  extended  and  exhaustive  inspection 
should  be  made  to  find  and  destroy  the  breeding 
places. 

In  the  case  of  the  Atlantic  Coast  mosquito,  on  the 
other  hand,  a  curious  and  interesting  fact  has  within 
recent  years  been  established.  Instead  of  hibernating 
as  the  winged  insect,  it  passes  this  stage  in  the  tgg 
form,  which  remains  in  the  soil,  and  when  the  warm 
weather  returns  it  hatches,  and  then  passes  through 
the  various  stages  of  development  already  mentioned. 

We  have  now  learned  sufficient  concerning  the  mos- 
quito and  its  habits  to  provide  efficiently  for  its  ex- 
termination. It  should  be  first  ascertained  what  va- 
riety is  being  dealt  with  in  order  that  the  breeding 
places  may  be  more  readily  found,  and  it  must  always 
be  borne  in  mind  that  breeding  places  should  be  de- 
stroyed rather  than  treated.  Sometimes  when  ground 
depressions  and  other  forms  of  receptacles  cannot  be 
removed  at  once,  recourse  must  be  had  to  some  tem- 


2i8  GOOD  HEALTH 

porary  agent  for  the  destruction  of  the  larvae.  Petro- 
leum oil  is  the  most  valuable  agent  for  this  purpose. 
It  does  not  poison  the  larvae,  as  is  generally  supposed, 
but  kills  them  by  suffocation.  We  have  already  learned 
that  the  larvae  extend  their  tails  above  the  water  every 
minute  for  air.  When  the  surface,  is  covered  with  oil, 
the  minute  opening  of  the  respiratory  tract  becomes 
plugged  and  death  follows  within  a  few  minutes. 

Crude  petroleum  does  not  spread  evenly  over  the 
surface  of  the  water,  for  it  is  too  thick.  Therefore, 
semi-crude,  or  partly  refined,  oil,  for  instance,  the 
brand  known  as  33  degree  fuel  oil,  should  be  used  for 
this  purpose.  This  quickly  forms  a  thin  film  over  the 
surface.  A  pint  of  this  material  is  ample  to  cover  an 
estimated  space  of  twenty-five  feet  in  diameter.  There 
is  no  better  way  of  applying  it  than  by  the  ordinary 
garden  sprinkling  pot  with  the  holes  in  the  expanded 
nozzle  enlarged  to  permit  the  free  exit  of  oil.  This 
should  be  applied  every  ten  days.  As  a  protection 
against  wetting  the  feet  those  who  distribute  the  oil 
should  wear  rubber  boots.  There  is  no  temporary 
agent  which  equals  in  value  the  oil  for  this  purpose. 

In  dealing  with  the  breeding  places  of  the  striped- 
legged  mosquito  it  is  hardly  necessary  to  state  that 
the  use  of  petroleum  oil  would  be  practically  worth- 
less, for  the  salt  water  swamps  are  sometimes  miles  in 
extent,  and  it  would  be  impracticable  to  attempt  to 
cover  the  surface  with  oil.  The  extermination  of  this 
variety  of  mosquito  must  depend  upon  drainage,  as  this 
is  the  only  way  that  the  swamps  can  be  kept  sufficiently 
free  of  water  to  prevent  propagation  of  mosquitoes. 


MOSQUITOES  AND  FLIES 


219 


Drainage  for  this  purpose  requires  the  construction 
of  ditches  about  ten  or  twelve  inches  across,  two  feet 
deep,  and  from  fifty  to  two  hundred  feet  apart,  depend- 
ing upon  the  character  of  the  swamp  land.    When  large 


Fig.  29. — Culex  sollicitans.    Salt  water  swamp,  or  striped-legged 

mosquito. 


areas  are  to  be  drained,  the  small  ditches  are  made  to 
connect  with  larger  drains  usually  three  or  four  feet 
wide,  which  conduct  the  water  to  the  sea.  It  is  true 
that  the  ditches  become  filled  when  the  flood  tide  oc- 
curs, but  the  water  remains  for  the  most  part  in  the 
ditches  rather  than  on  the  surface  of  the  swamp.  The 
swamp  also  drains  into  the  ditches,  which  are  practi- 


220  GOOD  HEALTH 

cally  emptied  at  ebb  tide.     By  this  means  permanent 
collections  of  water  on  the  swamps  are  prevented. 

Suggestions  are  sometimes  made  that  certain  kinds 
of  birds,  bats  and  other  insectivorous  animals  should 
be  propagated  for  the  destruction  of  mosquitoes.  Vari- 
ous species  of  fish  are  also  recommended  for  the  de- 
struction of  the  larvae  in  pools  and  streams.  Theoreti- 
cally, these  might  appear  to  be  of  value,  but  as  a  mat- 
ter of  fact  they  are  worthless,  for  even  an  enormous 
number  of  birds,  which  in  itself  would  constitute  a 
great  nuisance,  would  accomplish  little  in  the  reduction 
of  the  number  of  winged  insects.  These  theories, 
moreover,  are  harmful,  for  they  divert  public  attention 
from  the  only  method  by  which  mosquitoes  can  be  suc- 
cessfully exterminated,  that  is,  the  destruction  of  their 
breeding  places. 

FLIES 

Flies  are  perpetuated  from  one  season  to  another  in 
a  manner  similar  to  mosquitoes,  by  the  hibernation  of 
the  females,  which  seek  warm  protected  places  late  in 
the  season  and  remain  dormant  until  springtime,  when 
they  become  active  again  and  seek  some  place  to  de- 
posit their  eggs.  Entomologists  believe  that  flies  are 
also  perpetuated  in  the  form  of  pupae,  as  well  as  the 
winged  insect. 

The  house  fly  (Musca  domestica),  with  which  we 
are  particularly  concerned,  and  which  represents  over 
ninety  per  cent  of  those  found  indoors,  deposits  prob- 
ably one  hundred  and  fifty  eggs  at  a  time.  Only  ten 
or  twelve  days  elapse  between  the  dropping  of  the  eggs 
and  the  appearance  of  the  full  grown  insects.    The  fe- 


MOSQUITOES  AND  FLIES  '       221 

males  of  the  new  brood  in  their  turn  begin  to  lay  their 
eggs  in  a  few  days  after  birth.  The  number  of  off- 
spring which  a  single  female  is  accountable  for  during 
the  season  is  incalculable ;  it  has  been  roughly  estimated 
only  as  a  matter  of  interest  that  within  two  or  three 
months  it  would  exceed  250,000,000.  The  development 
of  the  fly  also  is  similar  to  that  of  the  mosquito.  First 
the  eggs  are  deposited ;  within  twenty-four  hours  these 
are  hatched  and  the  larvae  appear;  after  a  further  pe- 
riod of  five  or  six  days  the  latter  pass  to  the  pupal 
stage,  and  from  this  to  the  full-grown  fly  in  three  to  six 
days. 

The  larvae  are  well  known  as  "maggots,"  and  are 
about  one- fourth  to  an  inch  long.  They  are  white 
crawling  bodies  having  the  appearance  of  caterpillars. 
They  are  commonly  found  during  the  warm  weather 
upon  almost  any  manure  heap,  dead  animal  or  other 
decomposing  substance.  The  pupae  are  brown  in  color 
and  bean-shaped,  and  are  also  present  in  great  num- 
bers in  offensive  decomposing  material. 

More  recent  investigation  has  proven  that  horse 
manure  is  a  favorite  breeding  place  for  the  fly.  This 
knowledge  is  a  valuable  contribution  to  the  subject  and 
is  of  great  aid  in  exterminating  these  insects  or  dimin- 
ishing their  number.  It  follows  that  if  stables  are  kept 
clean  and  manure  promptly  collected  and  placed  in 
tightly  covered  receptacles  while  awaiting  removal  in- 
stead of  being  thrown  about  the  premises,  a  very  com- 
mon breeding  place  can  be  eliminated.  However,  it 
must  not  be  forgotten  that  flies  will  breed  wherever 
there  is  any  kind  of  filth.    Carelessness  regarding  ma- 


222  GOOD  HEALTH 

nure  heaps,  privy  vaults,  garbage  and  any  other  forms 
of  decomposing  matter  is  responsible  for  the  constant 
annoyance  of  flies  in  farmhouses  and  country  homes. 
Yet  it  is  here  that  the  best  sanitary  results  may  be  ob- 
tained; for  it  is  only  necessary  for  each  family  to 
abate  its  own  nuisance  to  obtain  relief  from  these  in- 
sects, while  in  the  city  one  must  suffer  from  the  care- 
lessness of  others. 

The  fly  is  not  only  a  very  annoying  insect,  but  re- 
liable proof  has  been  presented  that  it  is  also  a  medium 
of  infection.  For  this  reason  the  most  energetic  means 
should  be  taken  to  exterminate  it.  Flies  are  believed 
to  be  more  or  less  accountable  for  the  contamination 
of  food  and  drink  which  often  results  in  intestinal  in- 
fection and  which  commonly  occurs  during  the  warm 
weather,  principally  among  young  children.  Nearly 
5,000  deaths  from  this  cause  occurred  in  New  York 
City  during  19 10. 

There  are  many  varieties  of  flies,  some  of  which  are 
dangerous.  For  instance,  the  Tsetse  fly,  found  in 
Africa,  transmits  a  very  frequently  fatal  disease  known 
as  the  ^'sleeping  sickness."  This  variety,  as  well  as, 
some  of  our  domestic  flies,  bites ;  however,  the  common 
house  fly  with  which  we  are  chiefly  concerned  does 
not.  It  has  received  the  name  of  the  ''typhoid  fly,"  and 
is  believed  to  be  a  frequent  source  of  this  infection, 
particularly  in  the  country  and  in  sparsely  settled  dis- 
tricts where  privy  vaults  are  in  common  use.  While 
it  is  quite  probable  that  the  danger  from  this  source  is 
very  much  magnified,  there  is  good  reason  to  believe 
that  it  does  exist. 


MOSQUITOES  AND  FLIES  223 

It  is  also  reasonable  to  believe  that  milk,  both  in  the 
city  and  the  country,  is  contaminated  by  flies.  This 
also  applies  to  fruit  which  is  exposed,  for  instance,  at 
fruit  stands  and  by  street  vendors.  The  selling  of 
food  and  drink  in  public  streets  is  very  undesirable  and 
insanitary,  and  is  particularly  dangerous  to  children. 
It  is  probably  responsible  for  much  of  the  sickness 
among  them  attributed  to  other  causes. 

Unfortunately,  the  public  has  not  a  very  clear  under- 
standing as  to  the  means  by  which  flies  may  be  elim- 
inated, or  the  object  sought  in  carrying  out  this  im- 
portant sanitary  measure.  Innumerable  poisons,  fly 
catchers,  and  ''swatters"  are  on  sale  devised  for  the 
purpose  of  trapping  or  destroying  flies.  While  these 
are  very  popular,  they  have  little  or  no  practical 
value,  for  as  in  the  case  of  the  mosquito,  the  exter- 
mination of  flies  can  be  successfully  accomplished  only 
by  the  destruction  of  their  breeding  places. 

School  children  are  frequently  called  upon  to  assist 
in  the  destruction  of  flies.  As  already  stated,  that  is 
also  an  impractical  and  unscientific  means  of  elimina- 
tion, for  the  number  destroyed  in  this  way  is  so  infini- 
tesimally  small  as  compared  with  those  not  destroyed 
that  the  relief  is  entirely  fanciful.  Neither  can  this 
method  be  regarded  as  reliable  or  safe,  for  it  gives 
children  and  others  an  incorrect  idea  of  the  way  in 
which  this  work  should  be  performed.  Moreover, 
when  children  are  encouraged  to  catch  flies  for 
remuneration,  it  is  necessary  to  count  the  captured 
flies  in  order  to  determine  the  reward.  The  handling 
of  flies  in  large  quantities  under  these  conditions  is  in 


224  GOOD  HEALTH 

itself  dangerous,  for  they  wallow  in  filth,  and  it  is  not 
at  all  improbable  that  infection  may  result.  Further- 
more, children  should  not  be  employed  as  scavengers. 

Children  as  well  as  adults  can  render  valuable  aid  in 
the  extermination  of  flies  by  reporting  directly  or  indi- 
rectly to  the  municipal  department  of  health  the  loca- 
tion of  breeding  places  which  have  come  under  their 
observation.  This  enables  the  proper  authorities  to 
act  promptly  and  effectively  in  removing  these  insani- 
tary conditions. 

Protection  against  the  entrance  of  flies  into  the  house 
and  possibly  subsequent  infection  cannot  be  success- 
fully secured  by  traps ;  besides,  the  comparatively  few 
caught  by  such  means  are  not  always  ones  which  are 
dangerous  as  media  of  infection.  The  most  practical 
way  of  dealing  with  this  condition  is  the  use  of  screens, 
which,  curiously  enough,  are  rarely  constructed  and 
adjusted  to  accomplish  the  purpose  completely. 


CHAPTER  XIII 


TUBERCULOSIS 


There  is  no  disease  more  familiar  to  the  public  than 
tuberculosis,  also  known  as  phthisis  and  consumption^ 
and  it  is  the  one  which  most  commonly  affects  man- 
kind. Statistics  show  that  probably  one  out  of  every 
seven  deaths  throughout  the  world  is  due  to  this  dis- 
ease, and  at  least  150,000  persons  in  the  United  States 
succumb  to  it  every  year. 

From  this  rather  depressing  statement  we  turn  to  the 
most  comforting  part  of  the  subject — the  very  definite 
knowledge  concerning  the  means  by  which  tuberculosis, 
may  be  avoided,  and  the  hope  of  recovery  which  is 
promised  if  the  disease  is  detected  early  and  the  pa- 
tient promptly  and  carefully  treated. 

Tuberculosis  has  been  described  in  medical  Hterature 
for  centuries,  and  various  theories  have  been  suggested 
as  to  its  origin  and  the  means  of  transmission.  That 
it  is  an  infectious  disease  has  long  been  suspected,  for 
as  early  as  the  seventeenth  century  the  bedding  and 
clothing  of  consumptives  were  burned  in  order  to  pre- 
vent the  possible  danger  from  this  source.  Until  recent 
years,  the  belief  that  tuberculosis  is  hereditary  has  been 
generally  accepted,  and  its  appearance  among  various, 
members  of  a  family  has  been  explained  in  this  way. 

225 


.226  GOOD  HEALTH 

Other  theories  as  to  the  origin  of  this  disease  have 
from  time  to  time  been  advanced,  but  the  true,  cause 
was  not  definitely  determined  until  about  1880,  when 
Professor  Koch,  of  Germany,  discovered  that  tubercu- 
losis is  due  to  the  presence  of  an  organism  known  as 
the  ''tubercle  bacillus,"  a  minute  germ  revealed  only  by 
the  microscope.  It  is  through  the  medium  of  this  or- 
ganism that  tuberculosis  is  conveyed  from  one  person 
to  another;  therefore  heredity  plays  no  part  in  its 
transmission,  except  that  a  naturally  weak  resisting 
power  may  descend  from  parents  to  children,  and  in 
this  way  render  them  more  susceptible  to  this  as  well 
,as  other  diseases.  This  very  clearly  emphasizes  the  im- 
portance of  maintaining  a  strong  and  healthful  condi- 
tion of  the  body. 

It  has  been  proved  that  animals  and  fowls  have  cer- 
tain forms  of  tuberculosis.  It  is  only  that  which  af- 
fects cattle,  known  as  bovine  variety,  that  concerns  us, 
for  the  bovine  bacillus  is  similar  to  that  found  in  the 
human  being,  and  may  be  transmitted  through  the  me- 
dium of  infected  cow's  milk. 

Children  are  frequently  infected  by  cow's  milk,  and 
it  is  probable  that  one-quarter  of  all  cases  of  tubercu- 
losis in  children  under  the  age  of  five  years  are  con- 
tracted through  this  source.  For  various  reasons  adults 
rarely  contract  the  disease  in  this  way»  The  meat  of 
diseased  cows  may  also  cause  infection,  although  it  so 
seldom  occurs  that  it  is  practically  a  negligible  factor. 
To  a  great  extent,  this  is  due  to  the  fact  that  meat  is 
cooked  before  it  is  eaten,  and  by  this  means  the  or- 
.ganisms  are  quickly  destroyed.     Moreover,  meat  pre- 


TUBERCULOSIS  227 

pared  for  sale  is  now  subject  to  careful  municipal,  state 
or  Federal  inspection.  While  the  transmission  of  the 
bacillus  from  infected  cows  may  be  a  dangerous  factor 
among  very  young  children,  it  is  insignificant  in  this 
respect  in  comparison  with  the  infection  conveyed 
from  one  person  to  another  through  the  medium  of 
sputum,  by  which  means  more  than  ninety  per  cent  of 
all  cases  of  tuberculosis  are  contracted.  For  this  we 
are  largely  responsible,  for  if  modern  sanitary  regula- 
tions were  properly  observed,  the  number  of  cases  of 
the  disease  would  be  greatly  reduced. 

Modern  sanitation  demands  that  cows  shall  be  kept 
clean  and  under  careful  observation  and  that  every 
reasonable  means  shall  be  taken  to  detect  the  presence 
of  tuberculosis  among  them,  for  as  in  human  beings 
this  disease  in  its  early  stage  is  frequently  overlooked. 
The  tuberculin  test  constitutes  a  valuable  scientific 
means  of  detecting  tuberculosis  in  cows,  for  when  this 
agent  is  injected  a  certain  characteristic  reaction  fol- 
lows if  the  disease  is  present.  Its  accuracy  in  diag- 
nosis may  be  depended  upon.  As  a  rule  there  is  no 
valid  reason  why  owners  of  cows  should  not  make  use 
of  this  important  means  of  protection.  Cows  should 
not  be  purchased  unless  a  proper  and  satisfactory  cer- 
tificate is  presented  to  the  effect  that  a  tuberculin  test 
has  been  made  with  a  negative  result. 

While  tuberculous  deposits  may  take  place  in  various 
parts  of  the  body,  the  disease  usually  occurs  in  the 
lungs,  and  it  is  with  this  form  we  are  chiefly  concerned. 
The  germs  upon  reaching  the  lungs  as  a  rule  multiply 
rapidly  and  cause  local  inflammation  and  subsequent  loss 


228  GOOD  HEALTH 

of  tissue;  the  latter  will  account  for  the  cavities  in. 
these  organs  so  characteristic  of  the  later  stages  of  tu- 
berculosis.    This  broken  down  tissue  containing  tu- 
bercle bacilli  is  expelled  with  expectoration,  and  it  is  by 
this  means  that  infection  is  transmitted. 

Much  has  been  learned  in  regard  to  the  germ  itself. 
Experimental  work  has  shown  that  tubercle  bacilli, 
when  exposed  to  the  sunlight  and  fresh  air,  succumb 
within  a  very  short  time,  but  when  the  sputum  is  de- 
posited within  the  house,  particularly  when  the  apart- 
ments are  in  bad  sanitary  condition  and  there  is  but 
little  light  and  ventilation,  the  germs  may  retain  their 
"vitality  for  considerable  time,  although  not  so  long  as 
it  was  formerly  supposed.  This  admonishes  us  that  the 
danger  of  contracting  the  disease  is  not  in  -the  open 
air,  but  rather  within  the  house  or  workshop,  for  tu- 
berculosis is  essentially  an  indoor  disease.  Further- 
more, tuberculosis  is  to  a  certain  extent  a  class  disease, 
for  the  conditions  favorable  to  its  propagation  are 
more  often  found  among  the  poor  who  are  by  far  the 
most  frequent  victims  of  consumption. 

The  means  by  which  infection  takes  place  in  tuber- 
culosis or  rather  the  avenues  through  which  the  tu- 
bercle bacilli  most  frequently  reach  the  lungs,  is  still 
undecided.  Recent  investigation  has  thrown  consider- 
able doubt  upon  the  former  theory  that  the  infectious 
organisms  are  transmitted  directly  to  the  lungs  through 
the  respiratory  tract  or  the  bronchial  tubes.  It  is  now 
believed  that  the  bacilli  reach  these  organs  not  only 
through  the  air  passages,  but  also  through  the  stomach 
and  intestinal  tract,  by  swallowing  infectious  organ- 


TUBERCULOSIS  229 

isms,  and  also  by  taking  contaminated  food  and  drink. 
This  theory,  which  is  reasonable  and  logical,  is  slowly 
but  surely  gaining  ground.  Furthermore,  there  is  very 
satisfactory  proof  that  the  danger  of  contracting  tuber- 
losis  through  the  medium  of  outside  air  and  dust  has 
been  greatly  exaggerated ;  to  a  certain  extent  this  may 
be  said  of  house  dust. 

The  consensus  of  opinion  among  those  who  have 
given  this  subject  careful  and  exhaustive  investigation^ 
is  that  the  germ  of  tuberculosis  usually  enters  the  body 
by  contact.  By  this  is  meant  the  transmission  of  in- 
fectious germs  directly  from  one  person  to  another  or 
by  persons  within  a  very  short  distance  of  each 
other,  as  by  droplets  or  sprays.  This  includes  various 
means,  such  as  kissing,  contaminated  hands,  various 
articles  applied  to  the  mouth  which  are  used  in  com- 
mon, and  food  and  drink  containing  the  tubercle  bacilli. 

The  lesson  to  be  learned  from  this  is  that  persons 
and  not  things  transmit  tuberculosis,  that  we  need  not 
worry  about  clothing,  money  and  other  articles,  for 
there  is  practically  no  danger  from  this  source.  Every 
reasonable  effort  should  be  made  to  prevent  exposure 
to  fresh  pulmonary  discharges  from  tuberculosis  pa- 
tients, and  there  is  no  more  important  factor  in 
maintaining  this  protection  than  cleanliness. 

The  question  is  very  naturally  asked :  Why,  if  the 
germs  of  consumption  are  so  generally  distributed,  do 
so  many  of  us  escape  infection?  The  truth  is  we  do 
not  escape  it,  for  it  is  quite  certain  that  a  large  per- 
centage of  all  who  have  reached  adult  life,  particularly 
those  who  live  in  cities  and  large  towns  where  there  is 


230  GOOD  HEALTH 

close  association  among  people,  have  been  infected 
with  this  organism,  although  only  a  certain  proportion 
present  definite  evidence  of  the  disease.  This  is 
largely  due  to  the  resisting  power  of  the  body  which 
under  normal  and  healthy  conditions  permits  the  bacilli 
to  make  little  or  no  headway.  This  is  also  observed 
in  connection  with  the  germs  of  other  infectious  dis- 
eases. On  the  other  hand,  it  is  well  known  that  tuber- 
culosis very  commonly  follows  a  debilitating  disease, 
such  as  typhoid  fever  or  a  condition  which  for  the  time 
being  has  diminished  the  vital  forces. 

The  importance  of  maintaining  a  natural  resistance 
to  tuberculosis,  as  well  as  to  other  diseases,  in  the  way 
of  a  proper  observance  of  the  rules  of  personal  hygiene 
cannot  be  overestimated.  This  does  not  mean  that  we 
should  live  in  a  restricted  and  unnatural  way,  but  only 
that  we  should  preserve  a  normal  condition  of  health. 

Beyond  careful  attention  to  practical  and  logical  pre- 
cautions in  the  prevention  of  tuberculosis,  we  should 
dismiss  the  fear  of  it  from  our  minds  and  not  expect 
to  find  infection  lurking  everywhere,  for  this  is  not 
the  case. 

The  cure  for  tuberculosis  depends  chiefly  upon  the 
recognition  of  the  disease  in  its  early  stage.  Then  it 
is  far  more  successfully  dealt  with,  as  comparatively 
little  lung  tissue  is  involved  in  the  process  of  destruc- 
tion and  the  general  health  of  the  patient  is  not  so 
seriously  impaired. 

There  is  no  disease  where  recovery  rests  so  largely 
in  the  hands  of  those  affected,  for  there  is  no  medi- 
cine, vaccine,  serum  or  other  agent  which  can  be  de- 


TUBERCULOSIS  231. 

pended  upon  for  the  treatment  or  cure  of  tuberculosis. 
Advertisements  relating  to  so-called  consumption  cures, 
are  being  constantly  presented  to  the  public.  These, 
nostrums  are  offered  for  sale  with  the  most  attractive 
testimonials.  If  those  who  are  being  misled  by  these 
worthless  agents  could  know  of  the  lives  that  are  an- 
nually lost  by  depending  upon  them,  when  it  is  too  late 
to  derive  benefit  from  proper  sources,  it  would  go  far 
toward  eliminating  this  menace  to  public  health. 

While  the  cure  of  tuberculosis  depends  greatly  upon 
the  efforts  of  those  who  are  affected,  it  is  essential  that 
such  persons  should  be  under  medical  direction  and 
supervision,  and  very  frequently  so,  until  they  have 
learned  to  take  proper  care  of  themselves. 

It  is  not  expected  that  a  layman  will  be  able  to  rec- 
ognize tuberculosis  in  its  early  stages,  but  such  symp- 
toms as  loss  of  weight  and  appetite,  irritability,  fatigue 
and  continued  cough  should  be  regarded  as  a  warning 
and  a  physician  promptly  consulted  to  determine 
whether  or  not  there  is  any  evidence  of  pulmonary 
trouble.  In  the  beginning  of  the  disease  attention  may 
not  be  attracted  to  the  lungs.  Dependence  upon  domes- 
tic remedies  at  this  time  is  unfortunately  widespread 
and  is  to  be  condemned,  for  it  is  very  apt  to  prevent 
an  early  diagnosis  of  the  case.  This  does  not  refer 
to  the  careful  and  valuable  nursing  one  may  receive 
at  home  after  the  disease  has  been  identified. 

It  is  very  important  that  those  who  are  infected  with 
tuberculosis  should  bear  in  mind  that  the  principal 
factors  in  the  cure  of  this  disease  are  an  abundance  of 
good  food,  fresh  air  and  rest.     Unfortunately,  these 


232  GOOD  HEALTH 

xneans  are  not  always  available,  and  it  is  largely  for 
this  reason  that  recovery  does  not  more  often  take 
place.  Tuberculosis  patients  should  also  understand 
that  they  are  media  of  infection  and  it  is  only  fair  to 
the  public  that  they  should  take  every  reasonable  pre- 
caution to  prevent  the  spread  of  the  disease,  chiefly 
hy  cleanliness. 

As  infection  is  transmitted  chiefly  through  the  dis- 
charges from  the  respiratory  tract,  the  sputum,  or 
spittle,  should  be  received  in  receptacles  or  upon  some 
material  which  is  carefully  protected  and  promptly  de- 
stroyed by  burning.  Innumerable  and  inexpensive  de- 
vices for  this  purpose  may  be  purchased  almost 
anywhere.  Cuspidors  are  not  regarded  as  a  modern 
sanitary  device  and  when  used  for  the  reception  of  the 
sputum  of  tuberculosis  patients  are  very  liable  to  act 
as  foci  of  infection. 

It  is  also  very  important  that  the  hands  of  the  pa- 
tient, which  are  sure  to  be  contaminated  and  are  in  fre- 
quent contact  with  members  of  the  family  and  others, 
should  be  kept  thoroughly  cleansed  with  soap  and 
w^ater.  Articles  which  have  been  applied  to  the  mouth 
of  tuberculosis  patients  and  material  which  has  been 
soaked  with  sputum  should  be  burned  or  treated  with 
boiling  water  or  steam. 

The  foregoing  constitutes  in  a  general  way  the  pre- 
ventive measures  to  be  followed  in  dealing  with  tuber- 
culosis. However,  in  each  case  there  are  special  details 
to  be  considered  which  come  rather  within  the  province 
of  the  family  physician. 

It  is  frequently  asked  if  a  tuberculosis  patient  can  re- 


TUBERCULOSIS  233 

main  at  home  with  safety  to  other  members  of  the 
family.  This  may  be  answered  in  the  affirmative,  pro- 
vided every  reasonable  care  is  taken  by  the  patient  as 
well  as  the  various  members  of  the  family  to  prevent 
the  transmission  of  the  disease. 

If  modern  sanitary  methods  are  employed  in  con- 
nection with  the  care  of  patients  suffering  from  tuber- 
culosis, there  is  no  good  reason  why  general  disinfec- 
tion in  the  house  should  be  performed.  However, 
treatment  of  this  kind  is  often  advised  by  health  offi- 
cials, although  there  is  usually  little  or  no  justification 
for  it.  In  instances  where  medical  advice  is  not  avail- 
able, a  general  and  thorough  cleaning  with  soap  and 
water  will  extend  the  needed  protection. 

In  cities  and  large  towns  dispensaries  and  clinics 
may  be  found  for  the  treatment  of  the  poor.  There- 
fore in  these  places  there  is  no  reason  why  a  person  in 
any  station  of  life  should  not  be  able  to  obtain  proper 
medical  attention. 

It  is  the  duty  of  employers  to  observe  carefully  the 
physical  condition  of  their  employees.  If  this  is  done 
tuberculosis  may  be  detected.  This  is  not  only  in  the 
interest  of  those  who  may  be  affected,  but  also  for  the 
protection  of  fellow  workers.  It  is  also  to  the  advan- 
tage of  the  employers,  for  a  minimum  amount  of 
sickness  among  those  in  their  service  means  more  sat- 
isfactory and  less  interrupted  work,  and  really  consti- 
tutes an  economic  factor. 

Under  certain  conditions  and  in  the  incipient  stages 
of  this  disease,  with  the  approval  of  a  physician,  tu- 
berculosis patients  may  continue  their  work  without 


234  GOOD  HEALTH 

special  injury  to  themselves  or  others,  provided  they 
are  under  careful  modern  observation. 

Parents  and  guardians  have  an  important  duty  to 
perform  in  regard  to  tuberculosis,  for  this  disease  oc- 
curs principally  in  early  life  and  any  apparent  devia- 
tion in  the  health  of  those  under  their  care  should  call 
for  prompt  and  thorough  physical  examination. 


CHAPTER  XIV 

DISINFECTANTS   AND  DEODORANTS 

A  DISINFECTANT  IS  an  agent  which  destroys  the 
germs  or  organisms  with  which  it  comes  in  contact. 
An  antiseptic  retards  the  growth  of  germs  but  does 
not  necessarily  kill  them.  A  deodorant  neutralizes  of- 
fensive odors,  but  is  not  necessarily  destructive  to 
bacteria. 

A  large  number  of  preparations  advertised  for  sale 
as  disinfectants  are  worthless,  and  while  some  may  be 
germ  destroyers,  their  use  in  the  house  for  general  san- 
itary purposes  is  unnecessary  and  far  less  valuable  than 
cleanliness.  Besides,  disinfectants  are  demanded  only 
in  the  presence  of  infectious  disease. 

There  are  several  dependable  disinfectants,  such  as 
carbolic  acid  and  corrosive  sublimate,  yet  of  all  known 
agents  of  this  kind,  heat  is  the  most  valuable  and  cer- 
tain in  its  action.  Heat  in  some  form  is  always  avail- 
able; it  is  safe  and  its  expense  is  a  negligible  factor. 
Steam  and  boiling  water  are  the  most  practical  methods 
of  using  heat  for  disinfecting  purposes.  Boiling  water 
is  best  adapted  for  home  use,  while  steam  is  employed 
for  public  disinfection.  In  the  latter  case  an  appa- 
ratus is  required  which  is  more  or  less  complicated  and 
expensive. 

235 


236  GOOD  HEALTH 

It  has  already  been  explained  that  infectious  diseases 
are  transmitted  through  the  media  of  the  discharges  of 
those  who  are  sick.  Therefore  if  this  condition  occurs 
and  a  physician  is  not  promptly  available,  much  can  be 
done  by  the  family  in  preventing  the  extension  of  in- 
fection by  heating  articles  and  material  used  about  the 
patient,  which  are  presumably  contaminated  by  the  dis- 
charges. If  this  is  properly  performed  all  germs  thus 
exposed  will  be  destroyed. 

Simple  and  inexpensive  gas  or  oil  stoves  may  now 
be  purchased  almost  anywhere,  and  a  wash  pan  or  some 
form  of  metal  receptacle  for  boiling  the  water  can  be 
found  in  every  home.  It  is  true  that  boiling  water  can- 
not be  applied  to  the  skin  for  the  destruction  of  infec- 
tious organisms  which  may  be  present  on  the  surface 
of  the  body,  but  soap  and  hot  water  may  be  used  with 
almost  equal  value. 

It  should  be  remembered  that  articles  or  material  to 
be  disinfected  by  boiHng  water  must  be  kept  in  water 
which  must  be  constantly  boiling  for  at  least  five  min- 
utes. Simply  placing  the  articles  in  the  boiling  water 
which  is  allowed  to  cool  does  not  always  insure  dis- 
infection. A  small  amount  of  lime  placed  in  a  recep- 
tacle will  usually  prevent  any  unpleasant  odor  during 
disinfection.  This  treatment  should  be  carried  out  in 
the  sickroom  or  one  adjoining  in  order  to  prevent  the 
transmission  of  infectious  material  to  others. 

In  addition  to  the  use  of  boiling  water  as  a  disin- 
fectant, it  is  important  that  the  hands  of  those  in 
charge  of  the  sickroom  should  be  kept  well  washed  in 
soap  and  water,  particularly  upon  leaving  the  apart- 


DISINFECTANTS  AND  DEODORANTS      237 

ment  to  mingle  with  others.  If  the  patient  is  prop- 
erly isolated,  there  is  little  in  the  way  of  further  pre-' 
cautionary  measures  that  the  doctor  can  add  upon  his 
arrival. 

Antiseptics,  as  has  already  been  explained,  are  agents 
which  are  less  destructive  to  germs  than  disinfectants, 
and  are  used  by  physicians  under  various  conditions 
which  need  not  be  discussed  here. 

Deodorants  under  ordinary  conditions  are  not  re- 
quired about  the  house,  for  filth  which  generates  of- 
fensive odors  should  be  removed  and  not  treated. 
Sometimes,  however,  there  may  be  collections  of  filth, 
dead  animals,  etc.,  about  the  premises,  which  for  the 
moment  cannot  be  removed.  In  these  emergencies  deo- 
dorants are  called  for. 

A  true  deodorant  is  one  which  destroys  offensive 
odors  by  neutralizing  and  not  masking  them  with  a 
stronger  odor.  Bromin  at  one  time  was  regarded  as 
the  most  effective  agent  for  this  purpose,  but  its  use 
is  rather  dangerous,  for  it  violently  irritates  the  respir- 
atory tract,  so  much  so  that  in  making  solutions  for 
deodorizing  purposes  it  is  necessary  to  break  the  bottle 
containing  the  bromin  under  water.  Besides,  the  effect 
of  bromin  is  not  lasting. 

Lime  is  also  an  excellent  deodorant,  but  it  is  usually 
employed  in  the  form  of  a  powder  known  as  chlorid  of 
lime.  A  deodorant  of  this  kind  is  far  less  penetrating 
and  effective  than  one  in  fluid  form.  Probably  the 
most  valuable  and  simple  deodorant  is  prepared  by 
mixing  one  pound  each  of  lime  and  copper  with  ten 
gallons  of  water.     Copper  is  valuable  as  a  deodorant 


238  GOOD  HEALTH 

because  it  has  a  strong  affinity  for  sulphur.  Offensive 
odors  emanating  from  decomposed  organic  matter  are 
usually  due  to  the  formation  of  a  sulphur  compound 
with  which  copper  forms  insoluble  products. 

Ordinarily  sulphate  of  copper,  or  blue  vitriol,  costs 
about  five  cents  a  pound,  and  unslaked,  or  rock,  lime, 
may  be  purchased  for  three  cents  a  pound.  Therefore, 
this  ten-gallon  mixture  costs  only  eight  cents.  Lime 
may  be  obtained  either  in  barrels  or  tin  cans.  That 
purchased  in  cans  is  preferable,  as  it  is  better  protected 
against  the  entrance  of  air.  Lime  which  has  been  ex- 
posed, known  as  air-slaked  lime,  should  never  be  used. 
The  lime  required  for  the  above  purpose  must  not  be 
confused  with  chlorid  of  lime. 

In  preparing  this  mixture  in  sufficient  quantities  for 
a  stock  solution,  it  is  advisable  first  to  dissolve  the  cop- 
per by  placing  it  in  a  linen  bag  suspended  by  a  string 
in  the  cask  or  receptacle  just  below  the  surface  of  the 
water.  The  copper  may  be  dissolved  in  six  or  eight 
gallons  of  water,  leaving  the  remainder  of  the  ten  gal- 
lons for  mixture  with  the  lime.  This  is  done  by  placing 
the  lime  in  a  pail  or  other  receptacle,  and  gradually 
adding  water  and  stirring  until  the  steaming  or  slak- 
ing is  completed.  The  solution  of  lime  is  then  gradu- 
ally added  to  the  water  in  which  the  copper  has  been 
dissolved. 

Precipitation  always  takes  place  and  it  is  necessary 
to  stir  the  mixture  thoroughly  before  it  is  removed 
from  the  receptacle.  The  mixture  should  be  kept  in  a 
tightly  closed  receptacle  to  prevent  evaporation. 

In  the  treatment  of  offensive  material,  such  as  de- 


DISINFECTANTS  AND  DEODORANTS      239 

composed  organic  matter,  dead  animals,  fish,  garbage 
heaps,  offensive  vaults,  etc.,  no  complicated  apparatus 
is  necessary  for  the  application  of  this  mixture.  An 
ordinary  good-sized  sprinkling  pot  is  sufficient  for  the 
purpose.  As  the  mixture  is  rather  thick,  it  is  best  to 
enlarge  the  holes  in  the  sprinkler  with  an  awl  or  some 
similar  instrument.  In  treating  large  collections  of  of- 
fensive fluids,  the  sprinkling  pot  is  not  required;  add 
one  gallon  of  the  deodorizing  mixture  to  thirty  or  fifty 
gallons  (estimated)  of  the  fluid  to  be  treated. 

The  most  prompt  and  gratifying  results  may  be  ex- 
pected in  using  this  mixture  as  a  deodorant.  A  second 
application  is  not  usually  required,  although  it  may  be 
added  as  often  as  it  is  deemed  desirable.  Frequently 
the  mixture  will  adhere  to  or  stain  the  various  parts  of 
material  to  which  it  is  applied ;  this  may  afterwards 
be  removed  by  a  stream  of  water.  This  also  applies  to 
textile  fabrics. 

It  is  often  desired  to  destroy  insects  which  may  be 
present  in  an  apartment;  for  this  purpose  there  is  no 
more  effective  agent  than  sulphur  dioxid  gas,  which  is 
generated  by  burning  the  ordinary  rolled  sulphur.  This 
can  be  purchased  for  three  or  four  cents  per  pound 
anywhere.  About  four  pounds  of  it  should  be  burned 
for  every  thousand  cubic  feet  of  space ;  for  instance,  a 
room  ten  feet  square  and  ten  feet  high.  Great  care 
should  be  used  in  preparing  the  sulphur  for  combus- 
tion, for  the  least  amount  is  very  irritating  to  the  res- . 
piratory  tract.  Besides,  if  care  is  not  used  there  is 
danger  of  igniting  some  article  about  the  room. 

An  apparatus  for  burning  the  sulphur  may  be  impro- 


240  GOOD  HEALTH 

vised  in  any  home.  On  the  bottom  of  an  ordinary 
wash  tub  are  placed  two  or  three  bricks  to  support  a 
metallic  receptacle  for  the  sulphur,  such  as  the  ordinary 
milk-pan  or  a  galvanized  wash  basin.  The  tub  should 
be  filled  with  water  to  a  height  just  above  the  bricks 
and  the  bottom  of  the  receptacle ;  otherwise,  the  lat- 
ter may  be  burned  as  well  as  the  floor.  By  this  ar- 
rangement the  spluttering  of  the  burning  sulphur  is  far 
less  liable  to  cause  fire.  In  order  to  secure  as  far  as 
possible  the  complete  combustion  of  sulphur,  it  should 
be  broken  into  very  small  pieces  over  which  alcohol 
should  be  freely  poured.  Methyl  or  wood  alcohol, 
which  is  inexpensive,  will  answer  the  purpose.  After 
the  alcohol  has  been  applied  it  should  be  ignited  by 
dropping  a  lighted  match  or  piece  of  paper  upon  it, 
the  operator  at  the  time  standing  as  far  as  possible 
from  the  receptacle.  If  alcohol  cannot.be  obtained,  a 
lighted  coal  may  be  placed  in  the  mass,  although  the 
method  is  far  from  satisfactory. 

Before  the  sulphur  is  ignited  all  the  windows  and 
doors  in  the  apartment  except,  of  course,  the  door  for 
the  exit  of  the  operator,  should  be  carefully  closed  and 
sealed.  This  can  be  accomplished  with  strips  of  news- 
paper about  two  inches  wide  made  fast  with  common 
flour  paste;  after  leaving  the  room,  the  exit  door 
should  be  similarly  sealed.  These  seals  are  afterwards 
easily  removed.  There  should  be  an  exposure  of  six 
hours.  At  the  end  of  this  time  the  door  should  be  care- 
fully opened  by  someone  having  a  wet  sponge  or  towel 
held  to  his  nose  and  mouth,  to  protect  him  against  the 
remaining  gas.    Even  after  six  hours,  there  is  usually 


DISINFECTANTS  AND  DEODORANTS      241 

enough  sulphur  dioxid  left  in  the  apartment  to  irritate 
the  respiratory  tract  and  the  eyes.  A  window  should 
be  quickly  opened,  the  door  again  closed  and  the  re- 
mainder of  the  gas  allowed  to  escape. 

Sulphur  dioxid  gas  cannot  be  depended  upon  to  pen- 
etrate; therefore,  articles  which  are  supposed  to  con- 
tain certain  bugs  or  insects  should  be  freely  exposed. 
It  is  advisable  that  the  gas  should  be  generated  during 
the  day  in  order  that  the  room  may  be  freed  of  it  be- 
fore bedtime,  for  leaks  are  possible  through  windows 
and  doors,  and  unpleasant  results  might  occur  during 
the  night. 

Sulphur  dioxid  gas  is  commonly  used  for  room  dis- 
infection at  the  termination  of  a  case  of  infectious  dis- 
ease, although  there  is  but  little  or  no  justification  for 
this  procedure. 


CHAPTER  XV 

PROMPT   AID   TO   THE    INJURED 

The  object  of  prompt  aid  in  the  presence  of  injury 
or  sudden  illness  is  to  provide  immediate  assistance 
and  relief  until  the  doctor  arrives.  It  is  not  expected 
that  laymen  shallbe  familiar  with  the  scientific  meth- 
ods of  treating  the  various  injuries  v^hich  may  occur, 
nor  is  it  proper  for  those  v^ho  render  prompt  aid  to 
assume  that  they  are  competent  to  continue  the  treat- 
ment of  emergency  cases  which  come  under  their  care, 
for  they  are  not;  and  any  attempt  to  do  this  not  in- 
frequently becomes  a  source  of  danger.  This  is  jus- 
tifiable only  in  instances  where  physicians  are  not 
quickly  available. 

To  render  prompt  aid  successfully,  it  is  necessary  to 
know  something  of  the  emergencies  which  are  usually 
met  with  and  the  principles  under  which  they  are 
treated.  At  the  same  time  it  is  important  to  remember 
that  when  an  injury  takes  place,  unless  there  is  good 
evidence  that  it  is  of  a  most  trivial  character,  it  should 
•be  promptly  placed  under  the  care  of  a  physician. 

Prompt  aid  relates  chiefly  to  the  following  condi- 
tions : 

Hemorrhage 
Shock  or  collapse 
242 


PROMPT  AID  TO  THE  INJURED  243 

Fainting 

Apoplexy  or  stroke  of  paralysis 

Epilepsy 

Hysteria 

Asphyxia 

Drowning 

Burns  and  scalds 

Fractures  and  dislocations 

Poisoning 

HEMORRHAGE 

Hemorrhage  calls  for  the  most  energetic  action,  for 
beyond  a  certain  point  the  loss  of  blood  leads  to  a  fatal 
result. 

Hemorrhage  is  classified  as  arterial,  venous,  and 
capillary.  It  is  very  important  to  know  the  difference 
between  these  types,  for  upon  this  largely  depends  the 
successful  treatment  of  this  condition. 

In  arterial  hemorrhage,  the  blood  which  is  on  its 
way  from  the  heart,  having  just  been  purified  in  the 
lungs  by  the  oxygen  in  the  air,  is  a  bright  red  color, 
and  with  the  force  of  the  heart  directly  propelling  it,  is 
thrown  out  in  jets  and  spurts.  In  venous  hemorrhage, 
the  blood  flows  from  the  wound  in  a  slow  steady 
stream,  for  it  is  much  farther  removed  from  the  ac- 
tion of  •  the  heart  and  therefore  receives  much  less 
force.  Venous  blood  contains  various  impurities  or 
waste  matter  taken  up  from  the  tissues  of  the  body, 
and  is  deficient  in  oxygen,  and  for  this  reason  is  blu- 
ish in  color. 

Capillary  hemorrhage,  or  oozing,  comes   from  the 


244  •  GOOD  HEALTH 

very  small  blood-vessels,  and  except  in  the  case  of 
bleeders  is  not  of  a  very  serious  character.  It  is 
usually  controlled  without  difficulty. 

Treatment. — In  arterial  hemorrhage  where  a  good- 
sized  vessel  is  involved,  physicians  tie  or  ligate  the  ar- 
tery. It  is  hardly  necessary  to  state  that  this  is  not  to 
be  attempted  by  laymen  who  render  prompt  aid.  How- 
ever, a  valuable  temporary  substitute  to  be  employed  is 
in  the  form  of  pressure.  In  most  instances  if  this  is 
properly  applied  it  will  successfully  control  the  bleeding 
until  the  physician  arrives. 

In  order  to  apply  pressure  in  the  proper  manner, 
one  must  be  familiar  with  the  points  where  arterial 
trunks  or  main  arteries  come  close  to  the  surface  of 
the  body  and  may  be  easily  found.  For  this  reason 
the  accompanying  chart  (Fig.  30)  has  been  prepared 
and  should  be  carefully  studied. 

Pressure  should  always  be  made  between  the  heart 
and  the  wound  in  arterial  hemorrhage.  Digital  pres- 
sure, or  that  made  with  the  fingers  or  thumbs,  is  the 
most  effective,  but  it  is  available  only  for  a  short  time, 
unless  the  person  making  the  pressure  can  be  relieved 
at  short  intervals.  If  the  surgeon  is  expected  to  ar- 
rive promptly,  digital  pressure  should  be  depended 
upon,  for  it  is  safest  and  most  effective,  as  the  artery 
can  be  felt  and  the  pressure  kept  in  the  right  place. 
In  digital  pressure  the  thumb  is  generally  used. 

If  considerable  time  is  expected  to  elapse  before 
the  doctor  arrives,  and  there  is  not  a  sufficient  number 
of  persons  present  to  maintain  digital  pressure,  a 
firm  resisting  pad  may  be  applied  directly  over  the 


Fig.  30. — Diagrajii  showing  the  position  of  the  important 


PROMPT  AID  TO  THE  INJURED  245 

trunk  of  the  bleeding  artery.  The  most  effective  means 
of  securing  this  result  is  in  the  form  of  a  tourniquet, 
an  instrument  prepared  specially  to  arrest  hemorrhage 
by  compression. 

A  serviceable  improvised  tourniquet  or  compressor 
may  be  made  by  folding  a  large  handkerchief  in  the 
form  of  a  cravat  and  placing  between  its  folds  a 
smooth  round  stone,  piece  of  wood,  cork,  potato,  etc., 
or  a  good-sized  knot  tied  in  the  handkerchief.  The 
latter,  however,  is  inferior  to  the  others  mentioned. 
The  handkerchief  is  then  loosely  bound  around  the 
limb  and  tied,  the  portion  acting  as  the  pad  being 
placed  directly  over  the  trunk  of  the  artery  between 
the  wound  and  the  heart.  The  artery  can  be  located 
by  its  pulsation.  The  pad  is  held  securely  in  position 
while  a  stick,  cane,  bayonet,  sword,  or  other  article 
available  for  this  purpose  is  passed  between  the  hand- 
kerchief and  the  skin  on  the  side  of  the  limb  opposite 
the  pad,  and  twisted  slowly  and  carefully  until  the 
hemorrhage  ceases  or  is  greatly  lessened.  As  the  con- 
striction resulting  from  this  form  of  pressure  is  likely 
to  interfere  with  the  return,  or  venous,  circulation,  the 
tourniquet  should  be  occasionally  loosened  if  there  is 
danger  of  serious  obstruction.  If  swelling  and  blue- 
ness  of  the  part  below  the  point  of  hemorrhage  be- 
comes too  pronounced  digital  pressure  should  be  sub- 
stituted for  a  short  time.  A  handkerchief  is  given  as 
an  illustration  of  what  is  usually  available  for  this 
purpose,  although  parts  of  clothing,  neckties,  suspend- 
ers, rubber  tubing  or  other  material  are  equally  good, 
provided  they  fulfill  the  requirements. 


246  GOOD  HEALTH 

Venous  hemorrhage  is  far  more  easily  controlled 
than  arterial  hemorrhage,  for  the  pressure  within  the 
vessels  is  far  less.  It  may  be  successfully  dealt  with 
in  the  following  manner: 

1.  Remove  every  restriction  between  the  wound 
and  the  heart,  for  venous  blood  flows  towards  the 
heart. 

2.  Elevate  the  injured  part. 

3.  Apply  a  good  firm  compress  directly  over  the 
wound. 

Constriction  of  the  limb  beyond  the  seat  of  hemor- 
rhage or  toward  the  end  of  the  extremity  is  valuable, 
but  far  inferior  to  direct  pressure.  The  free  return  of 
blood  to  the  right  side  of  the  heart  is  aided  by  the  ele- 
vation of  the  limb  which  relieves  the  blood  pressure 
in  the  veins  in  the  immediate  vicinity  of  the  wound, 
and  consequently  the  hemorrhage  is  not  so  profuse. 

Capillary  hemorrhage  is  usually  not  dangerous  and 
generally  ceases  when  pressure  is  applied  or  when  the 
bleeding  surface  is  exposed  to  the  air.  It  may  be  suc- 
cessfully dealt  with  by  a  compress. 

Cold  is  also  a  very  valuable  means  of  controlling 
venous  and  capillary  hemorrhage,  and  aids  in  prevent- 
ing bleeding  from  the  small  arteries.  It  may  be  ap- 
plied in  the  form  of  cold  water,  ice  and  snow. 

Hot,  not  warm,  applications — temperature  120°  to 
125°  F. — may  also  be  used  for  this  purpose.  A  piece 
of  clean  flannel  wrung  out  in  water  as  hot  as  can  be 
borne  by  the  skin  and  applied  directly  to  the  bleeding 
surface  is  usually  followed  by  a  diminution  or  a  ces- 
sation of  hemorrhage.    Both  hot  and  cold  applications 


PROMPT  AID  TO  THE  INJURED  247 

contract  the  bleeding  vessels,  and  hasten  the  formation 
of  the  blood  clot,  one  of  nature's  means  of  arresting 
hemorrhage. 

Styptics  or  astringents,  such  as  preparations  of  iron, 
silver,  tannin  and  alum,  although  effective  agents  in 
arresting  venous  or  capillary  hemorrhage,  are  used  by 
surgeons  with  great  reluctance  and  only  in  special 
cases  or  where  other  means  are  not  available  or  ef- 
fective. They  prevent  the  early  healing  of  the  wound, 
and  their  use  may  be  followed  by  sloughing.  Alum  is 
one  of  the  least  objectionable  of  this  group. 

The  application  of  astringents  to  mucous  mem- 
branes (mouth,  nose,  etc.)  is  followed  by  more  fa- 
vorable results  than  when  applied  to  a  raw  surface. 

Rest  is  extremely  important  in  all  varieties  of  hem- 
orrhage as  it  favors  the  formation  and  retention  of 
the  blood  clot. 

Hemorrhage  in  the  scalp  is  easily  arrested  by  the 
use  of  a  compress  and  bandage  which  press  the  bleed- 
ing vessels  against  the  underlying  skull. 

Slight  hemorrhage  from  the  mouth  may  usually  be 
stopped  by  the  local  use  of  ice  and  astringent  (alum, 
tannin),  sometimes  by  alcohol  (brandy,  whisky,  etc.). 
If  these  agents  are  not  efficacious,  a  tampon  or  pad 
should  be  held  firmly  against  the  bleeding  part.  In 
severe  cases,  the  large  artery  in  the  neck  (see  Fig.  30) 
of  the  same  side  as  the  injury  may  be  compressed, 
although  this  only  should  be  done  as  a  last  resort. 

The  lips  are  supplied  with  arteries  which  divide  at 
the  angles  of  the  mouth  and  entirely  surround  the 
mouth.    When  the  lips  have  been  injured,  the  hemor- 


248  GOOD  HEALTH 

rhage  may  be  checked  by  pressing  the  sides  of  the 
wound  between  the  thumb  and  fingers. 

Severe  hemorrhage  following  the  extraction  of  a 
tooth  can  usually  be  controlled  by  the  application  of 
a  tampon  or  plug  saturated  with  a  strong  solution  of 
alum,  tannin  or  other  astringent  and  placed  in  the 
cavity. 

Epistaxis,  or  nose  bleed,  is  the  most  frequent  form 
of  internal  hemorrhage,  and  as  a  rule  may  be  controlled 
in  one  or  more  of  the  following  ways :  Elevation  of 
the  head  and  the  arms,  removal  of  all  restriction  about 
the  neck,  cold  applications  to  the  back  of  the  neck, 
forehead  or  sides  of  the  nose.  Passing  two  fingers 
beneath  the  upper  lip  and  directing  pressure  against 
the  base  of  the  nostrils  or  nose  is  very  useful.  Snuf- 
fing up  some  finely  powdered  tannin  or  alum  water  is 
often  employed  with  benefit. 

A  very  valuable  method  of  checking  severe  epistaxis 
is  by  the  use  of  a  clean,  thin,  rubber  finger-cot  or  pro- 
tector which  should  be  oiled  and  carefully  passed  into 
the  nasal  cavity  of  the  affected  side.  After  the  cot 
is  in  position  it  should  be  filled  or  partly  filled  with 
very  small  pieces  of  ice. 

In  severe  cases  of  epistaxis  which  resist  the  reme- 
dies already  enumerated  and  where  the  doctor  is  not 
expected  promptly,  the  affected  nasal  cavity  may  be 
tamponed  or  plugged  by  carrying  into  it  a  piece  of 
clean  gauze — antiseptic  if  possible — over  a  pencil  or 
other  agent  for  this  purpose.  When  the  pencil  is  with- 
drawn, the  cavity  left  in  the  gauze  is  packed  with  small 
pieces  of  cloth  or  cotton.    The  tampon  should  be  left  a 


PROMPT  AID  TO  THE  INJURED  249 

number   of   hours   and   never   forcibly   removed,   but 
should  be  loosened  by  injection  of  water  or  oil. 

SHOCK— COLLAPSE 

Shock  is  a  condition  resulting  from  a  severe  im- 
pression made  upon  the  nervous  and  circulatory  sys- 
tems either  by  a  physical  injury  or  a  mental  disturb- 
ance. The  majority  of  cases  dealt  with  are  the  result 
of  extensive  burns  or  other  grave  injuries,  such  as  gun- 
shot wounds  and  railway  accidents.  Electric  shock  is 
also  quite  common.  Severe  shock  may  be  produced  by 
fright  alone. 

Shock  may  be  of  a  mild  character  where  the  symp^ 
toms  are  hardly  noticeable,  or  it  may  be  rapidly  fatal. 
In  slight  shock  the  face  is  pale,  the  pulse  is  weak  and 
slight  nausea  may  be  present ;  a  general  feeling  of  de- 
pression always  occurs.  In  serious  cases,  the  extreme 
pallor  and  coldness  of  the  skin  is  very  pronounced; 
the  body  is  covered  with  moisture;  the  pulse  at  the 
wrist  may  be  lost,  or  if  perceptible,  is  very  weak, 
irregular  and  rapid;  the  features  are  shriveled,  par- 
ticularly about  the  nose  which  seems  pinched ;  the  eyes 
are  sunken  and  turned  upwards,  and  the  finger  nails 
are  of  a  bluish  color.  The  patient  is  conscious,  but 
dazed  and  flighty,  and  apparently  appreciates  only 
loud  and  repeated  questions,  and  sensibility  to  pain 
is  very  much  blunted. 

In  cases  which  end  favorably,  there  appear,  usually 
within  an  hour  or  so,  symptoms  denoting  an  increase 
in  the  strength  of  the  heart  and  circulation.  This 
.change  is  known  as  reaction  and  generally  indicates. 


250  GOOD  HEALTH 

as  far  as  the  shock  is  concerned,  a  favorable  termi- 
nation; although  other  results  of  the  injury  may  be 
fatal. 

Treatment. — As  an  illustration,  it  may  be  supposed 
that  a  man  has  been  injured  in  a  railway  accident  and 
is  found  in  a  condition  of  shock.  Those  who  attend 
the  case  should  at  once  loosen  the  clothing  and  make 
a  rapid  but  careful  examination  to  ascertain  if  hemor- 
rhage exists  or  if  some  condition  is  present  which  calls 
for  immediate  action.  If  for  any  reason  it  becomes 
necessary  to  move  the  patient,  his  head  should  be  kept 
as  low  if  not  lower  than  the  body  to  favor  the  flow 
of  blood  towards  the  brain.  If  possible,  four  per- 
sons should  arrange  to  carry  the  patient  to  insure 
greater  protection.  If  the  examination  indicates  that 
a  bone  has  probably  been  broken,  a  temporary  splint 
should  be  used  to  prevent  the  movement  of  the  frag- 
ments of  the  bones  during  transportation.  (See  Frac- 
tures.) Arriving  at  the  place  selected,  the  clothing 
should  be  quickly  and  carefully  removed  or  cut  away 
if  necessary  to  avoid  delay.  Then  the  patient  should 
be  placed  in  a  warm  bed  if  available,  his  head  being 
kept  low ;  blocks  under  the  foot  of  the  bed  will  accom- 
plish this. 

The  treatment  now  consists  in  applying  warmth  to 
the  surface  of  the  body  and  in  carefully  administering 
some  form  of  internal  stimulation.  The  first  indica- 
tion can  be  met  by  surrounding  the  patient  with  hot 
water  bottles,  or  hot  bricks,  stones,  etc.,  about  the 
arms  and  legs,  thighs  and  body,  but  not  about  the 
head,  for  when  reaction  occurs,  this  added  heat  may 


PROMPT  AID  TO  THE  INJURED  251 

favor  a  congestion  of  the  brain.  It  must  be  remem- 
bered that  the  sensibility  of  the  patient  is  blunted  and 
these  articles  may  burn  without  the  patient  knowing 
it;  therefore  they  should  be  carefully  watched.  A  hot 
plate  wrapped  in  a  towel  may  be  placed  over  the  heart, 
and  when  vomiting  occurs,  a  mustard  plaster  may  be 
applied  for  a  short  time  over  the  stomach.  Although 
friction  may  disturb  the  patient,  it  can  be  resorted  to 
when  heat  cannot  be  supplied  as  indicated  above. 

The  second  indication,  the  use  of  internal  stimula- 
tion, is  of  course  governed  by  the  condition  of  the 
patient.  If  he  is  able  to  swallow  he  should  be  given 
about  two  teaspoonfuls  of  whisky  or  brandy  with  some 
hot  water;  this  may  be  repeated  every  fifteen  minutes 
until  three  or  four  doses  have  been  taken,  or  reaction 
becomes  evident.  Persons  suffering  from  shock  are 
sometimes  unable  to  swallow ;  this  should  be  carefully 
ascertained  before  giving  anything  by  the  mouth,  as 
strangulation  may  ensue.  In  such  cases,  two  table- 
spoonfuls  of  brandy  or  whisky  in  a  cupful  of  warm 
water  may  be  introduced  into  the  rectum  by  the  ordi- 
nary rectal  syringe,  and  repeated  in  fifteen  or  twenty 
minutes.  In  place  of  this,  an  injection  of  a  cupful  of 
strong  coffee  may  be  employed ;  this  is  very  valuable. 
A  pint  of  water  as  hot  as  can  be  borne  by  the  hand,  in- 
jected into  the  rectum  is  also  of  benefit. 

Electric  Shock 

Treatment. — In  recent  years  the  enormous  increase 
in  electrical  work  of  various  kinds  has  been  responsible 
for  many  cases  of  accidental  electric  shock. 


252  .  .  GOOD  HEALTH 

The  treatment  of  this  condition  has  been  very  ably 
dealt  with  by  the  National  Electric  Light  Association 
in  the  form  of  published  rules  for  guidance  in  dealing 
with  these  emergencies.     The  following  are  extracts : 

An  accidental  electric  shock  usually  does  not  kill  at 
once,  but  may  only  stun  the  victim  and  for  a  while  stop 
his  breathing. 

The  shock  is  not  likely  to  be  immediately  fatal,  because : 

(a)  The  conductors  may  make  only  a  brief  and  imper- 
fect contact  with  the  body. 

(b)  The  skin,  unless  it  is  wet,  offers  high  resistance 
to  the  current. 

Hope  of  restoring  the  victim  lies  in  prompt  and  con- 
tinued use  of  artificial  respiration.  The  reasons  for  this 
statement  are: 

(a)  The  body  continuously  depends  on  an  exchange  of 
air,  as  shown  by  the  fact  that  we  must  breathe  in  and 
out  about  fifteen  times  a  minute. 

(b)  If  the  body  is  not  thus  repeatedly  supplied  with 
air,  suffocation  occurs. 

(c)  Persons  whose  breathing  has  been  stopped  by  elec- 
tric shock  have  been  reported  restored  after  artificial 
respiration  has  been  continued  for  approximately  two 
hours. 

The  Schafer,  or  "prone  pressure"  method  of  artificial 
respiration,  slightly  modified,  is  illustrated  and  described 
in  the  following  resuscitation  rules.  The  advantages  of 
this  method  are: 

(a)  Easy  performance;  little  muscular  exertion  is  re- 
quired. 

(b)  Larger  ventilation  of  the  lungs  than  by  the  supine 
method. 


PROMPT  AID  TO  THE  INJURED  253 

(c)  Simplicity;  the  operator  makes  no  complex  motions 
and  easily  learns  the  method  on  first  trial. 

(d)  No  trouble  from  the  tongue  falling  back  into  the 
air  passage. 

(e)  No  risk  of  injury  to  the  liver  or  ribs  if  the  method 
is  executed  with  proper  care. 

Aid  can  be  rendered  best  by  one  who  has  studied  the 
rules  and  has  learned  them  by  practice  on  a  volunteer 
subject. 

Instructions  for  Resuscitation 

Follow  these  instructions  even  if  victim  appears  dead. 

I.  Break  the  Circuit  Immediately. — With  a  single  quick 
motion  separate  the  victim  from  the  live  conductor.  In 
so  doing  avoid  receiving  a  shock  yourself.  Many  have, 
by  their  carelessness,  received  injury  in  trying  to  dis- 
connect victims  of  shock  from  live  conductors. 

Observe  the  following  precautions: 

(a)  Use  a  dry  coat,  a  dry  rope,  a  dry  stick  or  board, 
or  any  other  dry  non-conductor  to  move  either  the  victim 
or  the  wire,  so  as  to  break  the  electrical  contact.  Beware 
of  using  metal  or  any  moist  material.  The  victim's  loose 
clothing,  if  dry,  may  be  used  to  pull  him  away;  do  not 
touch  the  soles  or  heels  of  his  shoes  while  he  remains  in 
contact — the  nails  are  dangerous. 

(b)  If  the  body  must  be  touched  by  your  hands,  be  sure 
to  cover  them  with  rubber  gloves,  mackintosh,  rubber 
sheeting  or  dry  cloth ;  or  stand  on  a  dry  board  or  on  some 
other  dry  insulating  surface.  If  possible,  use  only  one 
hand. 

If  the  victim  is  conducting  the  current  to  ground,  and 
is  convulsively  touching  the  live  conductor,  it  may  be 
easier  to  shut  off  the  current  by  lifting  him  off  the  ground 
and  trying  to  break  his  grasp. 


254  GOOD  HEALTH 

Open  the  nearest  switch,  if  that  is  the  quickest  way  to 
break  the  circuit. 

If  necessary  to  cut  a  live  wire,  use  an  ax  or  a  hatchet 
with  a  dry  wooden  handle,  or  properly  insulated  pliers. 

2.  Send  for  the  Nearest  Doctor. — This  should  be  done 
without  a  moment's  delay,  as  soon  as  the  accident  occurs^ 
and  while  the  victim  is  being  removed  from  the  conductor. 

J.  Attend  Instantly  to  Victim's  Breathing. — (a)  As 
soon  as  the  victim  is  clear  of  the  live  conductor  quickly 
feel  with  your  finger  in  his  mouth  and  throat  and  remove 
any  foreign  body  (tobacco,  false  teeth,  etc.).  Then  begin 
artificial  respiration  at  once.  Do  not  stop  to  loosen  the 
patient's  clothing ;  every  moment  of  delay  is  serious, 

(b)  Lay  the  subject  on  his  belly,  with  arms  extended 
as  straight  forward  as  possible,  and  with  face  to  one  side, 
so  that  the  nose  and  mouth  are  free  for  breathing  (see 
F^g-  31)-  L^t  ^^  assistant  draw  forward  the  subject's 
tongue. 

If  possible  avoid  so  laying  the  subject  that  any  burned 
places  are  pressed  upon. 

Do  not  permit  bystanders  to  crowd  about  and  shut  off 
fresh  air. 

(c)  Kneel,  straddling  the  subject's  thighs  and  facing 
his  head;  put  the  palms  of  your  hands  on  the  loins  (on 
the  muscles  of  the  small  of  the  back),  with  thumbs  nearly 
touching  each  other,  and  with  fingers  spread  over  the  low- 
est ribs  (see  Fig.  31). 

(d)  With  arms  held  straight,  swing  forward  slowly 
so  that  the  weight  of  your  body  is  gradually  brought  to 
bear  upon  the  subject  (see  Fig.  32).  This  operation, 
which  should  take  from  two  to  three  seconds,  must  not  be 
violent — internal  organs  may  be  injured.  The  lower  part 
of  the  chest  and  also  the  abdomen  are  thus  compressed, 
and  air  is  forced  out  of  the  lungs. 


Fig.    31. — Artificial    respiration:    inspiration.      Pressure   off. 


Fig.    32. — Artificial    respiration:    expiration.      Pressure    on. 


255 


256  GOOD  HEALTH 

(e)  Now  immediately  swing  backward  so  as  to  remove 
the  pressure,  but  leave  your  hands  in  place,  thus  returning- 
to  the  position  shown  in  Fig.  31.  Through  their  elas- 
ticity, the  chest  v%^alls  expand  and  the  lungs  are  thus 
supplied  with  fresh  air. 

(f)  After  two  seconds  swing  forward  again.  Thus 
repeat  deliberately  twelve  to  fifteen  times  a  minute  the 
double  movement  of  compression  and  release — a  complete 
respiration  in  four  or  five  seconds.  If  a  watch  or  a  clock 
is  not  visible,  follow  the  natural  rate  of  your  own  deep 
breathing — swinging  forward  with  each  expiration,  and 
backward  with  each  inspiration. 

(While  this  is  being  done,  an  assistant  should  loosen 
any  tight  clothing  about  the  subject's  neck,  chest,  or 
waist.) 

(g)  Continue  artificial  respiration  (if  necessary,  two 
hours  or  longer),  without  interruption,  until  natural 
breathing  is  restored,  or  until  a  physician  arrives.  Even 
after  natural  breathing  begins,  carefully  watch  that  it 
continues.     If  it  stops,  start  artificial  respiration  again. 

During  the  period  of  operation  keep  the  subject  warm 
by  applying  a  proper  covering  and  by  laying  beside  his 
body  bottles  or  rubber  bags  filled  with  warm,  not  hot, 
water.  The  attention  to  keeping  the  subject  warm  should 
be  given  by  an  assistant  or  assistants. 

(h)  Do  not  give  any  liquids  whatever  by  mouth  until 
the  subject  is  fully  conscious. 

SYNCOPE— FAINTING 

Syncope,  or  fainting,  is  a  condition  of  suspended 
animation  associated  with  a  great  diminution  of  blood 
in  the  brain  and  unconsciousness  caused  by  sudden 
enfeeblement  of  the  heart's  action. 


PROMPT  AID  TO  THE  INJURED  257 

Fainting  may  be  the  result  of  disease  of  the  heart, 
hemorrhage,  pain,  excessive  emotion,  tight  lacing,  in- 
digestion, hunger,  exhaustion,  hot  and  vitiated  air, 
and  many  other  causes.  Before  the  stage  of  uncon- 
sciousness is  reached,  the  person  affected  experiences 
a  weak  and  sinking  feeling  with  dizziness,  dimness  of 
vision  and  roaring  in  the  ears.  The  face  and  extremi- 
ties become  cold  and  clammy. 

The  stage  of  unconsciousness  may  last  a  few  sec- 
onds or  an  hour  or  more  depending  upon  the  cause. 
During  this  period,  the  pulse  is  weak  and  almost  lost 
and  the  respiration  is  very  shallow  or  may  apparently 
cease.  Fainting  is  of  very  common  occurrence  and  is 
usually  not  associated  with  danger.  / 

Treatment. — The  patient  should  be  placed  in  a  re- 
cumbent position  with  the  head  as  low  or  lower  than 
the  body  to  favor  the  flow  of  blood  towards  the  brain. 
Fresh  air  is  a  very  essential  element  in  the  treatment 
of  fainting.  All  tight  clothing,  such  as  collars,  corsets, 
skirts  or  trousers,  should  at  once  be  loosened.  In  the 
ordinary  forms  of  fainting  due  to  simple  causes,  this 
treatment  is  all  that  is  required,  for  nature  very  soon 
asserts  herself.  In  other  cases,  smelling  salts  or  a 
handkerchief  or  the  palm  of  the  hand  moistened  with 
ammonia  or  other  stimulant  may  be  held  near  the  face, 
care  being  taken  that  none  drops  in  the  eyes  and  that 
it  is  not  held  too  close  to  the  face,  as  it  may  cause 
violent  irritation  of  the  air  passages.  The  head  and 
face  may  also  be  bathed  with  an  alcoholic  solution, 
such  as  camphor,  bay  rum,  etc. 

Friction  can  also  be  supplied  to  the  limbs.     Dash- 


258  GOOD  HEALTH 

ing  water  in  the  face  and  other  rough  methods  are 
to  be  deprecated,  for  it  must  be  remembered  that,  as 
a  rule,  nature  is  fully  able  to  deal  with  this  situation. 
Little  aid  is  required  beyond  placing  the  person  af- 
fected in  a  proper  position  with  free  air  and  the  re- 
lease from  tight  clothing. ' 

In  some  cases,  probably  where  heart  disease  exists, 
it  will  be  necessary  to  resort  to  more  active  measures. 
If  the  syncope  continues  with  no  signs  of  returning 
consciousness,  stimulants  may  be  injected  into  the 
rectum  with  the  ordinary  syringe  in  the  manner  re- 
ferred to  in  shock.  A  mustard  plaster  may  be  applied 
over  the  heart  for  a  short  time  and  friction  of  the 
limbs  may  be  employed,  and  in  some  extreme  cases, 
artificial  respiration  may  be  required.  (See  Instruc- 
tions  for  Resuscitation.) 

After  recovery  from  fainting  a  person  should  be 
kept  quiet  until  the  action  of  the  heart  and  circulation 
are  properly  strengthened. 

Shock  and  syncope  are  somewhat  similar  and  may 
be  due  to  the  same  causes.  Shock  usually  follows 
severe  injuries,  while  fainting  may  be  due  to  some 
trivial  cause.  It  should  be  remembered  that  in  shock 
the  patient  is  more  or  less  conscious,  while  in  fainting 
or  syncope  the  patient  is  unconscious.  The  history  of 
the  case  goes  far  to  establish  the  diagnosis. 

APOPLEXY  OR  STROKE  OF  PARALYSIS 

Apoplexy  is  a  sudden  loss  of  consciousness  asso- 
ciated with  paralysis  due  to  the  failure  of  a  portion  of 
the  brain  to  perform  its  function  as  a  result  of  hem- 


PROMPT  AID  TO  THE  INJURED  259 

orrhage  from  a  diseased  cerebral  vessel.  The  hemor- 
rhage occurs  on  one  side  of  the  brain  and  the  paralysis 
takes  place  on  the  opposite  side  of  the  body  for  the 
reason  that  the  nerves  coming  from  the  brain  cross 
from  one  side  to  the  other.  This  has  been  referred  to 
in  a  previous  chapter. 

Apoplexy  usually  affects  persons  somewhat  advanced 
in  years,  and,  as  a  rule,  is  not  preceded  by  any  warn- 
ing. The  attacks  not  infrequently  follow  a  hearty 
meal.  If  unconsciousness  does  not  occur  at  once,  it 
does  so  very  shortly  afterwards,  and  the  patient  can- 
not be  aroused.  The  face  becomes  reddened  and 
congested ;  the  respiration  is  slow,  labored  and  snor- 
ing or  stertorous,  the  cheeks  being  puffed  out  during 
respiration;  convulsions  may  occur.  The  important 
diagnostic  sign  is  paralysis  usually  of  one  side  of  the 
body. 

Treatment. — The  principal  object  of  treatment  is  to 
arrest  further  hemorrhage  from  the  brain,  conse- 
quently the  head  should  be  slightly  elevated  and 
cracked  ice  or  some  other  form  of  cold  applied.  The 
clothing,  particularly  about  the  neck  and  waist,  should 
be  loosened.  Internal  stimulants^  which  tend  to  in- 
crease the  hemorrhage,  must  not  be  used.  If  possible, 
warmth  should  be  applied  to  the  extremities.  The 
further  treatment  must  be  indicated  by  the  medical 
attendant. 

Apoplexy  must  be  distinguished  from  fainting  and 
intoxication.  In  fainting  the  face  is  pale,  the  pulse 
weak  and  the  respiration  shallow  or  apparently  sus- 
pended; the  attack  is  usually  of  short  duration.     In 


26o  ,GOOD  HEALTH 

apoplexy  the  face  is  congested,  the  breathing  is  noisy 
or  snoring,  and  paralysis  of  one  side  of  the  body  is 
usually  noticeable.  In  intoxication,  the  subject  can 
usually  be  roused,  paralysis  is  not  present  and  vom- 
iting commonly  occurs ;  the  odor  of  alcohol  is  gener- 
ally present.  The  last,  however,  may  also  be  pres- 
ent in  apoplexy,  for  the  attack  may  be  associated  with 
excessive  drinking.  This  must  be  carefully  considered 
for  apoplexy  is  not  infrequently  mistaken  for  intoxi- 
cation. 

EPILEPSY 

Epilepsy  is  an  affection  of  the  brain  which  at  vari- 
able intervals  gives  rise  to  an  attack  characterized  by 
convulsive  movements  and  unconsciousness.  Subjects 
of  this  disease  are  usually  warned  of  the  approach  of 
paroxysms ;  the  premonitions,  however,  are  as  a  rule 
of  short  duration.  The  person  affected  may  utter  a 
sharp  piercing  cry  and  fall  to  the  ground  in  a  helpless 
and  unconscious  condition.  He  is  often  seriously  in- 
jured in  this  way.  At  first  there  is  more  or  less  rigid- 
ity of  the  muscles;  this  is  quickly  succeeded  by  con- 
vulsive movements;  the  eyes  are  usually  opened  and 
turned  upwards,  the  face  becomes  livid  and  congested ; 
the  jaws  are  brought  together  with  considerable  force 
and  the  tongue  is  often  badly  wounded  by  the  teeth. 
There  is  also  considerable  foaming  and  frothing  at  the 
mouth.  The  paroxysm  lasts  but  a  few  minutes  and 
consciousness  gradually  returns,  the  patient  being  in 
a  stupid  and  drowsy  condition  with  headache  for  some 
time  afterwards. 

Treatment, — The  patient  should  be  placed  in  the 


PROMPT  AID  TO  THE  INJURED  261 

recumbent  position  (on  the  back),  all  clothing  being 
loosened,  particularly  about  the  neck.  A  handkerchief 
knot,  a  piece  of  wood  or  some  other  suitable  article, 
which  will  prevent  injury  to  the  tongue,  should  be 
placed  between  the  teeth,  although  not  allowed  to  drop 
into  the  mouth.  After  the  fit  is  over  no  further  treat- 
ment is  usually  required,  although  it  should  be  re- 
membered that  sometimes  a  temporary  aberration  of 
mind  may  follow.  If  this  occurs,  the  patient  should 
be  watched  for  some  time  after  the  seizure. 

HYSTERIA 

Hysteria  is  a  functional  affection  of  the  mind  and 
nervous  system,  usually  affecting  women.  It  is  char- 
acterized by  temporary  loss  of  will  power  and  with 
considerable  emotional  display;  the  affected  person 
laughs  and  sobs  immoderately  without  regard  to  sur- 
roundings. 

The  importance  of  giving  this  condition  special  con- 
sideration lies  in  the  fact  that  it  sometimes  assumes  a 
form  which  may  be  mistaken  for  syncope,  shock  or 
epilepsy,  according  to  the  manifestations  of  the  patient. 
A  case  of  hysteria  may  be  distinguished  from  fainting 
as  follows :  In  fainting  the  face  and  extremities  are 
cold  and  the  pulse  is  very  weak  and  apparently  lost, 
whereas  in  hysteria  the  face  and  extremities  are  warm 
and  the  pulse  is  normal.  An  effort  to  open  the  eye- 
lids in  hysteria  meets  with  opposition,  but  with  none 
in  fainting.  In  hysteria  which  simulates  epilepsy,  the 
tongue  is  not  injured,  and  if  the  patient  falls  to  the 
ground  a  suitable  place  is  selected  for  this  purpose  to 


^62  GOOD  HEALTH 

avoid  injury.     There  is  no  frothing  at  the  mouth  un- 
less soap  or  other  agents  are  used  for  this  purpose. 

Treatment. — The  most  effective  treatment  for  hys- 
teria is  to  let  the  person  alone;  to  sympathize  usually 
prolongs  the  attack  and  does  no  good.  Firmness  on 
the  part  of  the  attendant,  with  an  intimation  that  the 
condition  is  fully  understood  is  usually  all  that  is  re- 
quired. It  is  a  common  practice  to  douche  a  hyster- 
ical patient  with  cold  water ;  there  is  very  little  excuse 
for  such  rough  treatment,  particularly  as  the  person 
affected  is  apt  to  be  a  delicate  woman. 

HEAT-STROKE,    SUN-STROKE,    INSOLATION,    SUN- 
FEVER,    FEVER   HEAT 

The  term  heat-stroke  is  now  used  to  denote  the 
various  manifestations  which  sometimes  follow  ex- 
posure to  intense  solar  or  artificial  heat.  Those  who 
are  employed  in  hot  and  close  apartments  where  the 
air  is  impure,  as  in  mines  and  in  fire-rooms  of  steam- 
ers, are  particularly  liable  to  be  affected  by  heat-stroke. 

It  is  a  fact  worthy  of  notice  that  those  who  gen- 
erally suffer  from  this  malady  are  either  addicted  to 
the  excessive  use  of  stimulants  or  are  in  a  weak  and 
debilitated  condition. 

Heat-stroke  does  not  always  develop  abruptly,  nor 
does  it  generally  occur  at  the  beginning  of  the  heated 
term,  but  usually  after  the  hot  weather  has  persisted 
for  two  or  three  days.  There  are  certain  symptoms 
which  indicate  the  approach  of  this  affection  and 
should  be  recognized  as  a  warning;  viz.,  an  irritable 
and  depressed  condition,  headache,  congestion  of  the 


PROMPT  AID  TO  THE  INJURED  263 

eyes,  flushing  of  the  face,  dryness  of  the  skin  and 
sometimes  nausea.  Unless  the  person  affected  seeks 
relief,  the  symptoms  just  enumerated  may  be  followed 
by  more  serious  ones,  as  delirium,  convulsions  and 
unconsciousness.  In  this  connection  the  temperature 
of  the  body  has  been  known  to  rise  to  108°  to  110°  F. 
— normal  temperature  being  98.6°.  The  pupils  are 
generally  dilated,  although  sometimes  contracted.  The 
pulse  at  first  is  strong  and  rapid,  but  subsequently 
becomes  weak.  Death  may  occur  suddenly  in  con- 
sequence of  the  action  of  the  high  temperature  upon 
the  nerve  centers,  or  at  a  later  period  as  the  result 
of  exhaustion.  A  large  percentage  of  those  who  re- 
cover from  the  immediate  effect  of  heat-stroke  sub- 
sequently suffer  from  some  temporary  or  permanent 
affection  of  the  nervous  system. 

Treatment. — There  are  two  important  indications 
for  treatment:  reduction  of  temperature  and  the  use 
of  stimulants.  The  use  of  cold  is  regarded  as  the 
best  method  of  meeting  the  first  indication,  and  the 
manner  of  its  application  depends  upon  the  facilities 
at  hand.  The  patient  should  be  removed  to  a  cooler 
spot  if  possible,  or  at  least  where  shade  can  be  se- 
cured, or  if  a  person  succumbs  in  a  place  where  the 
ventilation  is  defective,  in  addition  to  the  heat,  he 
should  be  carried  into  the  fresh  air.  The  treatment 
should  be  begun  at  once.  Efforts  are  often  made  to 
take  the  patient  home  which  may  involve  considerable 
time  and  cause  still  further  exhaustion. 

The  clothing  about  the  neck  and  body  must  either 
be  removed  or  loosened.     Cold  is  particularly  indi- 


264  GOOD  HEALTH 

cated  in  cases  where  the  body  is  greatly  heated  and 
delirium  and  convulsive  movements  are  present.  This 
means  of  reducing  the  temperature  may  be  applied  by 
cracked  ice  about  the  head  and  spine,  or  by  cold  water 
by  means  of  a  sponge,  sprinkling  pot,  or  hose,  the 
pressure  being  carefully  regulated.  However,  a  good 
plan  is  to  remove  the  clothing  and  sponge  the  body 
with  cold  water  at  frequent  intervals.  In  extreme 
cases  it  may  be  necessary  to  wrap  the  patient  in  sheets 
wet  with  cold  water.  The  sheets  are  to  be  kept  wet 
by  frequently  pouring  water  over  them  while  on  the 
body  until  consciousness  returns  or  there  is  evidence 
of  marked  fall  of  temperature.  After  the  cold  has 
been  discontinued,  should  serious  symptoms  such  as 
unconsciousness  or  a  return  of  the  previous  high  tem- 
perature occur,  the  cold  applications  should  be  re- 
peated. 

If  there  is  evidence  of  great  depression,  stimulants 
must  be  used  while  the  cold  is  being  applied. 

There  are  some  cases  of  heat-stroke  where  stimu- 
lants alone  are  indicated,  as  when  the  signs  of  a  high 
fever  are  absent,  great  depression  is  present,  the  skin 
is  cold  and  blue  and  the  pulse  is  weak.  In  these  cases 
in  addition  to  the  use  of  judicious  internal  stimula- 
tion, the  application  of  mustard  over  the  heart  and  to 
the  calves  of  the  legs  is  indicated. 

The  treatment  of  simple  heat  exhaustion  consists  in 
rest,  bathing  the  face  with  an  alcoholic  solution  and 
the  judicious  internal  use  of  a  stimulant. 


PROMPT  AID  TO  THE  INJURED  265 

ASPHYXIATION— SUFFOCATION 

Asphyxiation  is  a  condition  of  unconsciousness  due 
to  a  largely  diminished  amount  of  oxygen  in  the  blood 
resulting  from  an  obstruction  in  the  passage  of  air 
to  the  lungs,  or  to  the  presence  of  poisonous  gases 
which  render  the  air  unfit  for  respiration.  Among 
the  ordinary  causes  of  suffocation  are  drowning,  hang- 
ing, obstruction  in  the  respiratory  tract,  either  by  the 
lodgment  of  foreign  bodies  or  by  certain  maladies 
affecting  this  part,  as  diphtheria,  and  the  inhalation  of 
the  fumes  of  charcoal  or  coke  and  the  carbonic  acid 
gas  contained  in  empty  wells,  caves,  beer  vats  and 
mines.  In  mines  it  is  known  as  ''choke  damp."  Coal 
gas  from  stoves  and  illuminating  and  sewer  gases  are 
also  a  frequent  cause  of  suffocation.  The  appearance 
of  a  person  suffering  from  asphyxia  is  characteristic. 
The  face  is  of  a  dusky  or  purplish  hue,  owing  to  defi- 
cient oxygenation  of  the  blood,  and  swollen.  The  res- 
piration is  extremely  labored  and  associated  with  con- 
vulsive movements  and  delirium.  If  relief  is  not 
promptly  at  hand,  these  symptoms  are  rapidly  fol- 
lowed by  unconsciousness  and  death. 

Treatment. — The  treatment  of  asphyxiation  consists 
in  removing  the  cause  in  order  that  the  lungs  may 
be  supplied  with  the  proper  amount  of  pure  air, 
and  restoring  the  different  functions  to  their  nor- 
mal condition  by  stimulants  and  artificial  respira- 
tion. 

Precautions. — In  rescuing  a  person  from  an  empty 
well,  for  instance,  care  should  be  taken  that  the  mouth 


266  GOOD  HEALTH 

and  nose  of  the  person  making  the  descent  are  pro- 
tected by  holding  against  them  a  cloth  saturated  with 
water  or  vinegar  and  water.  A  rope  should  also  be 
tied  around  the  waist  of  the  rescuer  by  which  he 
can  be  brought  rapidly  to  the  open  air.  Matches 
should  not  be  ignited  while  in  the  well,  nor  should 
any  artificial  light  be  carried  down,  for  while  car- 
bonic acid  gas,  which  constitutes  the  bulk  of  poison- 
ous gases  in  these  receptacles,  does  not  support 
combustion  other  gases  may  be  present  which  are 
ignitable  and  a  serious  explosion  would  probably 
follow. 

Sewer  gases  are  often  inflammable  and  illuminating 
gases  always  so.  A  light  should  never  be  taken  into  a 
cellar  or  any  apartment  where  gas  has  escaped  until 
the  room  has  been  thoroughly  ventilated  by  open  doors 
and  windows. 

It  is  often  necessary  to  enter  empty  wells  and  cess- 
pools in  order  to  examine  or  clean  them.  The  car- 
bonic acid  gas  which  they  contain  and  which  is 
heavier  than  air  and  consequently  settles  to  the  bot- 
tom, should  be  stirred  up  and  removed  previous  to 
making  any  descent  for  examination.  This  may  be 
done  by  free  ventilation,  by  pouring  into  the  well  large 
quantities  of  water  or,  even  better,  lime  water,  by 
lowering  and  quickly  withdrawing  an  opened  um- 
brella, or  throwing  down  lighted  papers  and  straw. 
Should  the  last  be  done,  care  should  be  taken  not  to 
remain  near  the  opening  as  inflammable  gases  may  be 
present.  A  gun  may  be  discharged  into  these  recep- 
tacles for  this  purpose. 


PROMPT  AID  TO  THE  INJURED  267 

Drowning 

The  asphyxiation  or  suffocation  that  follows  sub- 
mersion is  due  to  the  fact  that  the  air  is  prevented 
from  reaching  the  lungs.  More  or  less  water  is  found 
in  the  air  passages,  but  not  in  such  quantities  as  is 
generally  supposed.  In  some  cases  very  little,  if  any, 
water  reaches  these  organs  on  account  of  the  rapid 
closure  of  the  epiglottis,  the  covering  of  the  wind- 
pipe. Water  also  enters  the  stomach,  and  considerable 
is  found  mixed  with  the  mucus  in  the  throat.  Death 
is  usually  the  result  of  suffocation.  However,  in  some 
cases  it  may  be  due  to  sudden  heart  failure  before 
the  person  sinks.  When  such  is  the  case,  the  face  of 
the  person  is  pale  and  flabby,  and  very  little  water  and 
mucus  is  found  in  the  respiratory  tract.  There  is  a 
better  chance  of  resuscitating  a  person  who  sinks  as 
the  result  of  syncope  than  when  suffocated,  as  the 
demand  for  oxygen  in  the  former  is  less  than  when 
asphyxiated  by  submersion. 

Persons  who  are  submerged  for  four  or  five  min- 
utes or  more,  are  not  usually  restored  to  life,  although 
numerous  cases  are  recorded  where  resuscitation  was 
effected  after  an  interval  of  twenty  minutes  or  so. 
In  such  cases  it  is  supposed  that  syncope  occurred, 
or  on  account  of  the  existing  excitement,  an  error  was 
made  in  calculating  the  actual  time  of  submersion. 
The  action  of  the  heart  usually  continues  for  some 
time  after  respiration  ceases. 

Treatment, — This  consists  first  in  reestablishing 
respiration,  then  stimulating  the  action  of  the  heart 


268  GOOD  HEALTH 

and  circulation  by  stimulants,  warmth,  friction,  etc. 
When  a  person  has  been  under  water  but  a  very  short 
time,  simple  means  may  restore  respiration,  and  the 
following  procedure  should  be  tried: 

The  water,  sand  and  mucus  should  first  be  quickly 
removed  from  the  mouth  and  nose.  The  attendant 
should  then  carry  his  finger  to  the  back  or  base  of 
the  patient's  tongue,  which  must  be  pulled  forward 
to  permit  the  water  and  mucus  in  the  throat  and 
respiratory  tract  to  escape,  and  also  to  favor  the  en- 
trance of  air  into  the  lungs.  While  this  is  being  done, 
the  patient  should  be  turned  on  his  side,  left  if  pos- 
sible, face  downward  to  favor  the  escape  of  water 
from  the  stomach  and  air  passages.  He  should 
then  again  be  turned  on  his  back,  while  the  hands 
of  the  attendant  are  placed  on  the  abdomen  and 
pressure  directed  upward  and  inward  toward  the  dia- 
phragm. This  movement  tends  to  stimulate  respira- 
tion and  should  be  repeated  two  or  three  times  at 
intervals  of  two  or  three  seconds.  The  mouth  in 
the  meantime  should  be  kept  open  by  a  cork  or  piece 
of  wood,  or  a  knot  tied  in  a  handkerchief,  etc.,  in 
order  that  the  passage  of  air  in  the  lungs  should 
not  be  interfered  with.  Smelling  salts,  ammonia  or 
two  or  three  drops  of  nitrate  of  amyl  placed  on 
a  handkerchief  or  on  the  attendant's  hand  may  be 
administered  by  inhalation,  or  the  nose  may  be 
tickled  with  a  feather  or  straw.  When  breathing 
commences  and  consciousness  returns,  the  patient 
should  be  carefully  divested  of  all  wet  clothing — if 
necessary  the  clothing  should  be  cut  to  avoid  delay — 


PROMPT  AID  TO  THE  INJURED  269 

well  rubbed,  and  wrapped  in  warm  covering,  and  stim- 
ulants given  in  the  manner  already  described.  (See 
Shock.) 

If  the  simple  measures  just  described  are  not 
successful  after  a  brief  trial,  artificial  respiration 
should  be  resorted  to.  Before  this  is  begun,  the  pa- 
tient should  be  stripped  to  the  waist  or  at  least  cloth- 
ing around  the  waist  should  be  loosened,  so  that  the 
necessary  manipulations  may  not  be  hindered.  It  must 
be  remembered  that  in  artificial  respiration,  the  normal 
respiratory  action  of  about  eighteen  respirations  per 
minute  should  not  be  exceeded.  This  is  often  over- 
looked.    (See  Instructions  for  Resuscitation.) 

BURNS  AND   SCALDS 
Burns 

These  injuries  are  caused  by  the  action  upon  the 
tissues  of  some  form  of  dry  heat  or  by  a  chemical 
agent.  For  practical  purposes  burns  are  divided  into 
three  degrees:  (i)  simple  redness  of  the  skin;  (2) 
vesication  or  the  formation  of  blisters;  (3)  more  or 
less  destruction  or  charring  of  the  skin  and  deeper 
structures. 

Burns  of  the  first  and  second  degree  are  usually 
unattended  by  serious  consequences.  However,  it  is 
said  that  when  they  involve  more  than  one-half  of 
the  body,  the  result  is  generally  fatal. 

Burns  of  the  third  degree  are  dangerous  accord- 
ing to  their  situation,  extent  and  complications.  When 
the  chest  or  abdominal  walls  are  involved,  the  condi- 
tion may  prove  very  serious. 


270  GOOD  HEALTH 

Death  following  burns  is  usually  the  result  of  shock 
during  the  first  twenty- four  hours,  internal  inflam- 
mation, ulcers  or  hemorrhage,  blood  poisoning,  tet- 
anus (lockjaw),  or  exhaustion. 

The  temperature  of  the  body  falls  immediately 
after  a  severe  burn  occurs;  this  is  temporary  and  is 
soon  followed  by  fever. 

In  burns  of  the  third  degree  which  heal  by  granu- 
lation, or  the  formation  of  new  tissues,  the  contrac- 
tion of  the  scar  and  the  subsequent  deformity  are 
marked. 

Treatment. — The  treatment  of  burns  is  divided  into 
local  and  constitutional.   • 

The  local  treatment  depends  upon  the  degree  to 
which  it  belongs.  In  burns  of  the  first  degree,  rem- 
edies which  are  soothing  and  protective  should  be 
applied.  Among  those  which  generally  can  be  ob- 
tained at  once,  are  bicarbonate  of  soda  (common  bak- 
ing soda,  not  washing  soda),  starch,  chalk,  magnesia, 
charcoal  and  boric  acid  powder.  One  of  these  may  be 
freely  dusted  over  the  surface.  Lime  water  may  also 
be  used.  An  application  commonly  used  for  this  pur- 
pose and  known  as  ''Carron  oil"  (first  used  in  the 
Carron  Mines),  is  composed  of  equal  parts  of  lime 
water  and  linseed  oil,  and  is  yery  soothing  and  excel- 
lent for  this  class  of  burns.  Vaseline  or  olive  oil  may 
also  be  used.  These  should  be  freely  applied  to  the 
surface  and  covered  with  an  antiseptic  gauze  or  a  piece 
of  clean  linen  or  muslin,  and  retained  by  a  bandage. 

In  burns  of  the  second  degree,  the  blisters  require 
special  treatment.     If  the  clothing  is  attached  to  the 


PROMPT  AID  TO  THE  INJURED  271 

burn,  it  should  never  be  forcibly  removed,  but  care- 
fully cut  off  with  scissors  as  close  to  the  burn  as  pos- 
sible. The  small  piece  adhering  to  the  skin  may  be 
washed  away  with  warm  water,  or  softened  with  oil 
and  detached  later.  If  the  blisters  are  large  they 
should  be  pricked  at  their  lowest  point  with  a  large 
needle,  the  point  of  which  has  been  held  in  a  flame 
for  a  few  seconds  to  destroy  any  source  of  infection 
which  may  be  present.  The  cuticle  over  the  blister 
should  not  be  removed,  for  it  acts  as  a  protection  to 
the  raw  surface.  The  oily  substances  recommended 
for  burns  of  the  first  degree  may  then  be  carefully  ap- 
plied. 

In  burns  of  the  third  degree  where  there  is  destruc- 
tion of  tissue,  more  or  less  sloughing  will  subsequently 
occur  with  possibly  some  serious  complications.  Un- 
der these  conditions  it  is  extremely  important  that  the 
patient  should  be  placed  in  the  hands  of  a  physician 
as  promptly  as  possible.  Therefore,  emergency  dress- 
ing need  be  only  some  simple  covering  as  a  temporary 
means  of  protection,  for  it  will  be  necessary  sooner  or 
later  to  remove  dead  tissue  and  carry  out  various 
means  of  treatment  applicable  to  this  condition. 

In  burns  caused  by  acids,  generally  sulphuric,  nitric 
and  muriatic  acids,  water  should  not  be  applied,  for 
when  combined  with  acids,  an  elevation  of  the  tem- 
perature of  the  mixed  fluids  immediately  follows.  The 
proper  remedy  should  be  the  application  of  an  alkaline 
powder — bicarbonate  of  soda,  magnesia,  chalk  or  lime ; 
the  last  may  be  scraped  off  whitewashed  walls.  These 
agents  neutralize  the  acid;  they  should  be  left  on  the 


2^2  GOOD  HEALTH 

surface  for  a  few  minutes  and  then  washed  off.    Di- 
lute ammonia  water  may  also  be  used. 

If  an  acid  is  splashed  into  the  eye,  lime  water,  soda 
or  magnesia  in  solution  should  be  applied  at  once. 
Burns  of  the  mouth  and  the  throat  from  the  same 
cause  should  also  be  treated  by  the  free  use  of  the  al- 
kalies already  mentioned. 

Burns  caused  by  caustic  alkalies — caustic  soda,  pot- 
ash, lime,  ammonia,  quicklime  and  lye — should  be 
treated  by  acid  solutions,  such  as  diluted  vinegar, 
lemon  juice,  hard  cider,  etc. 

,  After  the  acid  or  alkali  causing  the  burn  has  been 
neutralized,  the  oily  substances  already  referred  to 
should  be  applied  as  in  ordinary  burns. 

Some  of  the  severest  forms  of  burns  follow  catch- 
ing fire  of  some  portion  of  the  wearing  apparel.  A 
person  whose  clothes  are  afire  should  be  at  once  en- 
veloped in  a  blanket,  mat,  piece  of  carpet,  the  coat  of 
someone  present,  or  whatever  may  be  at  hand  for  this 
purpose,  or  the  victim  may  be  rolled  over  the  floor 
to  extinguish  the  flames.  Water  should  be  used  freely, 
and  the  clothing  carefully  examined  to  ascertain  if  the 
fire  has  been  entirely  extinguished.  The  burned  sur- 
face should  then  receive  proper  attention. 

Scalds 

These  are  injuries  produced  by  the  application  of 
moist  heat,  boiling  water,  steam,  etc.  Children  often 
suffer  from  them  as  the  result  of  pulling  over  recep- 
tacles containing  hot  water,  coffee  and  tea.  Scalds 
should  be  treated  as  burns  of  the  first  and  second  de- 


PROMPT  AID  TO  THE  INJURED  273 

grees.  The  constitutional  treatment  of  burns  and 
scalds,  as  far  as  prompt  aid  is  concerned,  deals  chiefly 
with  shock  which  has  already  been  described. 

FROST-BITE 

Prolonged  exposure  of  the  body  to  a  very  low  tem- 
perature results  in  a  general  or  local  loss  of  vitality. 
If  the  air  is  still,  it  is  favorable  to  the  one  exposed, 
but  when  the  wind  is  blowing,  the  warm  air  close  to 
the  surface  of  the  body  is  rapidly  removed  and  the 
destructive  effect  of  the  cold  is  considerably  increased. 
An. exposure  of  one  or  two  hours  may  be  followed  by 
a  fatal  result.  Persons  succumbing  to  extreme  cold 
are  soon  overcome  by  an  irresistible  sense  of  drowsi- 
ness and  desire  to  sleep.  To  yield  to  the  inclination  is 
usually  fatal.  This  disposition  to  stupor  is  due  to  the 
great  diminution  in  the  blood  supply  to  the  surface  of 
the  body  and  consequent  congestion  of  internal  organs. 
In  this  condition  the  brain  is  unable  to  perform  its 
function  and  drowsiness  follows. 

When  a  person  becomes  frozen,  the  limbs  become 
stiff  and  the  skin  turns  bluish  or  purplish  and  then 
white.  These  changes  in  the  color  of  the  skin  denote 
that  the  circulation  of  the  surface  of  the  body  is  pro- 
foundly interfered  with.  This  is  often  followed  by 
excessive  reaction,  inflammation  and  gangrene. 

Treatment. — A  frozen  person  should  not  be  taken 
into  a  warm  room,  or  have  warmth  applied  to  the 
body.  An  abrupt  change  in  temperature  would  prob- 
ably prove  fatal.  The  temperature  of  the  body  must 
be  gradually  raised;  the  patient  should  be  taken  to  a 


274  GOOD  HEALTH 

cool  apartment,  the  clothing  removed,  and  the  body 
rubbed  with  snow  or  cold  water.  After  a  short  time, 
if  consciousness  returns  and  the  limbs  lose  their  rig- 
idity, friction  with  a  piece  of  flannel  or,  still  better, 
the  hand,  can  be  substituted  for  the  cold  applications. 
A  little  later  the  continuous  rubbing  should  be  discon- 
tinued and  occasional  friction  resorted  to.  These 
measures  must  be  pursued  very  gently,  as  rough  ma- 
nipulation may  destroy  the  skin.  In  some  cases  ar- 
tificial respiration  may  be  called  for.  (See  Instruc- 
tions for  Resuscitation.) 

Stimulants  should  be  carefully  administered.  If  the 
patient  cannot  swallow,  they  may  be  given  by  the  rec- 
tum, as  in  shock.  Nourishment  in  the  form  of  beef 
tea  or  milk  should  be  given  as  soon  as  the  patient  can 
take  it.  The  surface  of  the  body  should  be  carefully 
protected  and  not  subjected  to  heat,  as  some  time  will 
elapse  before  the  circulation  regains  its  equilibrium. 

WOUNDS 

A  wound  is  an  injury  of  the  outer  tissues  of  the- 
body  associated  with  more  or  less  division  of  the  skin 
and  soft  structures,  and  produced  by  a  mechanical 
•agent.  Wounds  are  classified  as  follows :  incised,  lac- 
erated, punctured,  poisoned  and  contused. 

Incised  wounds  are  made  by  sharp  cutting  instru- 
ments, as  knives  and  razors.  The  edges  of  a  wound, 
when  applied  to  each  other,  fit  accurately  and  complete- 
ly close  the  opening.  Hemorrhage  constitutes  one  of 
the  principal  dangers  of  this  form  of  injury,  for  the 
blood-vessels  are  evenly  divided,  and  the  openings  are 


PROMPT  AID  TO  THE  INJURED  275 

not  so  quickly  closed  as  when  the  wound  is  jagged. 

Lacerated  wounds  are  made  by  stones,  clubs  or  im- 
plements which  are  rough  and  blunt  and  produce 
more  or  less  destruction  of  tissues  about  the  wound, 
the  edges  of  which  are  ragged  and  torn.  Consider- 
able local  inflammation  and  constitutional  disturbance 
often  follow  lacerated  wounds. 

Punctured  wounds  are  inflicted  by  bayonets,  dag- 
gers, swords,  arrows,  or  other  weapons  which  are  sharp 
and  narrow-pointed.  Snake  bite  is  also  a  form  of 
punctured  wound.  Although  the  openings  are  quite 
small,  these  wounds  usually  penetrate  to  a  considerable 
depth  and  may  injure  important  blood-vessels  and  vital 
organs,  or  may  introduce  infectious  matter. 

Gunshot  wounds  are  caused  by  bullets,  cannon  balls 
and  the  like.  The  danger  resulting  from  gunshot 
wounds  depends  upon  the  hemorrhage,  particularly 
that  occurring  internally,  the  injury  to  organs  in- 
volved, the  amount  of  tissue  destroyed,  the  shock  and 
the  subsequent  inflammation,  suppuration  and  blood- 
poisoning. 

Foreign  substances,  such  as  bits  of  clothing,  are 
often  carried  into  the  body  by  bullets  and  other  mis- 
siles, frequently  beyond  observation,  and  constitute 
an  additional  element  of  danger.  The  point  of  en- 
trance of  a  ball  is  apt  to  be  smaller  than  the  exit,  as 
a  result  of   diminished   velocity. 

Poisoned  wounds  are  caused  by  the  introduction  into 
the  tissues  through  the  skin  of  some  form  of  virus,  as 
that  of  a  snake  bite.  These  wounds  are  usually  punc- 
tured, although  they  may  be  lacerated,  as  in  the  bite  of 


.276  GOOD  HEALTH 

a  rabid  dog.  Contrary  to  the  general  belief,  the  bite  of 
the  venomous  snakes  in  this  country,  such  as  the  rat- 
tlesnake, moccasin,  copperhead,  and  one  or  two  oth- 
ers, is  not  generally  fatal,  and  although  the  virus  acts 
with  great  rapidity  and  intensity,  only  about  one  out 
-of  every  seven  or  eight  bitten  dies  from  this  cause. 
Snakes  are  most  dangerous  in  warm  weather  and 
after  fasting.  A  person  who  has  been  bitten  by  a  poi- 
sonous serpent  becomes  faint  and  depressed  within  a 
few  minutes,  the  pulse  feeble  and  the  pupils  dilated. 
More  or  less  delirium  occurs  and  the  extremities  be- 
come cold  and  clammy.  Considerable  swelling  and 
discoloration  usually  take  place  about  the  wound;  in- 
tense pain  is  also  present.  In  fatal  cases,  death  may 
'Occur  within  a  few  hours. 

A  contused  wound  is  one  in  which  the  division  of 
"the  soft  structures  is  associated  with  more  or  less 
-contusion  or  bruising  at  the  site  of  injury. 

Healing  of  Wounds. — Although  the  method  of  heal- 
ing of  wounds  is  divided  by  physicians  into  many  va- 
rieties, it  will  be  sufficient  in  this  description  to  rec- 
ognize but  two  of  them :  immediate  union,  and  union 
by  granulation. 

Immediate  union  usually  occurs  when  the  edges  of 
the  wound  fit  accurately  and  are  not  displaced  by  hem- 
orrhage or  improper  dressing,  when  foreign  bodies 
are  removed,  the  wound  properly  cleaned  and  the 
injured  part  kept  immobile.  It  is  always  desirable  to 
obtain  this  result,  for,  aside  from  other  advantages,  it 
prevents  disfiguring  scars. 

Wounds  associated  with  considerable  destruction  of 


PROMPT  AID  TO  THE  INJURED  277 

tissue,  as  lacerated  wounds  and  burns  of  the  third  de- 
gree, heal  by  granulation.     The  first  step  in  this  form 
of  repair  is  the  removal  by  nature  of  the  destroyed 
and  useless  tissues  about  the  wound  by  the  process, 
known  as  suppuration  and  sloughing.  After  the  wound 
is  thus  cleared,  granulation,  or  filling  in,  takes  place- 
After  granulation  has  entirely  filled  the  wound,  the 
upper  surface  becomes  smooth,  shining  and  red,  which 
appearance  is  the  result  of  the  process  of  cicatrization, 
and  is  known  as  a  scar,  or  cicatrix.    The  glands  of  the 
destroyed  skin  are  not  reproduced,  and  hair  does  not 
grow  from  the  new  formation. 

The  proper  healing  of  wounds  is  commonly  inter- 
fered with  by  severe  local  inflammation  and  constitu- 
tional disturbances  due  to  the  presence  of  germs  or 
bacteria  which  infect  the  wound.  This  condition  has 
developed  within  recent  years  a  method  of  treatment,, 
the  purpose  of  which  is  to  retard  or  destroy  the  growth 
of  these  microscopic  organisms,  a  most  important  con- 
sideration. Modern  methods  have  clearly  demon- 
strated the  inestimable  value  of  cleanliness  in  the  treat- 
ment of  wounds. 

Treatment— The  treatment  of  a  wound  consists. 
of  the  following  procedure:  arrest  of  hemorrhage,  ex- 
amination of  the  wound,  the  removal  of  foreign  mat- 
ter, dressing,  support  and  protection  of  the  injured 

part  and  rest. 

The  variety  of  hemorrhage  should  be  determmed,, 
whether  arterial,  venous  or  capillary,  and  arrested  in 
the  manner  already  described. 

A   wound   should   be   examined   as   to   its   variety. 


278  GOOD  HEALTH 

whether  incised,  lacerated,  etc.,  and  also  as  to  the 
structures  involved.  A  careful  search  should  be  made 
for  foreign  bodies,  v^hich  if  allowed  to  remain  would 
interfere  with  the  proper  healing  of  the  part.  Pieces 
of  clothing,  splinters,  etc.,  should  be  picked  out  with 
clean  forceps  or  fingers,  and  tincture  of  iodin  should 
be  applied  to  the  surface  of  the  open  wound  by  a 
pledget  of  clean  cotton  or  some  other  light  material 
which  is  handy.  The  tincture  of  iodin  is  now  used  as 
a  quick,  safe  and  effective  means  of  destroying  bac- 
teria or  germs  which  may  be  on  the  surface  of  a 
wound  and  which  cause  infection  and  interfere  with 
the  proper  healing  of  the  part.  This  has  already  been 
referred  to. 

Further  treatment  in  the  absence  of  the  surgeon  de- 
pends upon  the  character  of  the  wound.  If  incised, 
the  edges  should  be  brought  closely  together,  and  re- 
tained in  apposition  by  applying  over  the  opening  a 
compress  preferably  made  of  antiseptic  gauze,  or  a 
clean  piece  of  muslin,  and  then  holding  the  parts  to- 
gether by  strips  of  adhesive  plaster.  This  is  a  sub- 
stitute for  the  proper  closing  of  the  wound  by  the  use 
of  suture  or  stitches,  which  hold  the  edges  closely  to- 
gether and  favor  accurate  union.  The  strips  of  ad- 
hesive plaster  should  not  entirely  surround  the  limb, 
as  they  would  interfere  with  the  circulation.  They 
should  be  applied  at  intervals  to  allow  the  free  exit  of 
any  matter  or  pus  which  may  form  at  the  site  of  in- 
jury. One  end  of  the  strip  should  be  placed  on  one 
side  of  the  wound,  the  edges  of  which  are  held  closely 
together,  and  the  remainder  of  the  strip  should  be  car- 


PROMPT  AID  TO  THE  INJURED  279 

ried  over  the  edges  and  made  fast.  On  removing 
adhesive  plaster,  both  ends  of  the  strip  should  be 
loosened  at  the  same  time,  and  carried  from  the  skin 
toward  the  wound,  thereby  preventing  the  separa- 
tion of  its  edges.  The  compress  should  be  held  in  place 
by  a  bandage  of  some  kind  which  keeps  the  edges  of 
the  wound  together. 

Lacerated  wounds  which  are  associated  with  more 
or  less  destruction  and  loss  of  tissue  heal  by  granu- 
lation; consequently  no  effort  need  be  made  to  bring 
the  edges  too  closely  together,  which  might  subse- 
quently interfere  with  the  proper  escape  of  discharges. 
Otherwise,  the  same  kind  of  dressing  should  be  applied 
as  in  incised  wounds. 

The  immediate  local  treatment  of  a  punctured 
wound  is  very  simple,  and  consists  in  applying  a  cov- 
ering over  the  puncture.  The  result  of  such  a  wound 
is  extremely  uncertain;  it  depends  upon  the  imple- 
ment causing  the  injury  and  should  be  carefully 
watched  for  any  subsequent  evidence  of  inflammation 
or  infection. 

In  gunshot  wounds,  the  first  effort  should  be  to 
arrest  the  hemorrhage,  protect  the  wound  with  dress- 
ing and  treat  the  accompanying  shock.  All  foreign 
bodies  which  are  about  the  surface  of  the  wound  and 
are  not  retained  by  blood  clots  can  be  removed.  No 
exploration  for  the  bullet  should  be  made  except  by 
a  surgeon.  The  wound  should,  if  possible,  be  dressed 
antiseptically  and  splints  applied  to  prevent  movement 
of  the  limb.  The  patient  should  be  conveyed  at  once  to 
a  place  where  he  can  secure  the  proper  surgical  treat- 


28o  GOOD  HEALTH 

■ment,  for  wounds  of  this  character  are  frequently  as- 
sociated with  tetanus  or  lockjaw. 

When  a  person  has  been  bitten  by  a  snake,  he  should 
immediately  endeavor  to  remove  the  poison  by  suction. 
If  the  wound  be  inaccessible  to  the  patient  himself, 
this  may  be  done  by  someone  else  willing  to  assume 
the  risk.  It  is  believed  that  the  venom  has  no  effect 
upon  the  mucous  membrane  of  the  mouth  unless  cuts 
or  abrasions  are  present.  Cuts  or  abrasions  of  the  lips 
may  admit  the  poison.  If  a  leg  or  arm  is  bitten,  in  ad- 
dition to  suction,  the  part  should  be  immediately  sur- 
rounded by  a  tight  bandage  between  the  wound  and 
the  heart.  This  is  an  effort  to  prevent  or  retard  the 
absorption  of  the  poison  into  the  system.  It  should 
not  be  forgotten  that  the  bandage  should  be  occasion- 
ally loosened  to  prevent  any  serious  interference  with 
the  general  circulation  of  the  part.  Cauterization 
would  be  of  no  value  in  this  variety  of  poisoned  wound. 
The  depression  that  follows  the  absorption  of  the 
poison  demands  the  use  of  stimulants — whisky  or 
brandy,  for  instance.  It  is  not  necessary  or  proper, 
however,  that  the  patient  should  be  made  intoxicated. 
If  necessary,  stimulants,  properly  diluted,  may  be 
given  by  the  rectum,  always  in  larger  doses  than 
those  given  by  mouth. 

The  prompt  treatment  of  a  wound  caused  by  the  bite 
of  a  dog  supposed  to  be  suffering  from  rabies,  or  hy- 
drophobia, is  substantially  the  same  as  in  snake  bites, 
although  if  suction  is  impracticable  by  the  person 
bitten,  the  wound  may  be  cauterized  by  heating  the 
blade  of  a  pen-knife,  button-hook  or  piece  of  wire,  red 


PROMPT  AID  TO  THE  INJURED  281 

hot,  and  applying  it  to  the  wounded  surface.  The  poi- 
son introduced  does  not  develop  rapidly  and  the  con- 
stitutional symptoms  may  not  appear  for  weeks ;  there- 
fore, stimulants  are  indicated  only  when  shock  is  pres- 
ent. The  suspected  animal  should  be  at  once  closely 
confined  until  under  professional  guidance  it  is  killed 
and  specimens  secured  and  forwarded  to  some  labo- 
ratory, where  they  can  be  examined  to  determine 
whether  or  not  rabies  exists.  The  Pasteur  treatment 
of  this  injury,  by  the  injection  of  the  antirabic  emul- 
sion, is  now  regarded  as  successful,  and  prompt  sci- 
entific procedure  fortunately  may  be  carried  out  with 
little  difficulty. 

The  wounds  caused  by  tarantulas,  centipedes,  spi- 
ders, bees,  wasps  and  other  insects  are  very  seldom 
dangerous.  The  local  application  of  dilute  ammonia 
or  a  solution  of  bicarbonate  of  soda  is  regarded  as  the 
most  effective  remedy,  and  generally  relieves  the  pain 
at  once.  Wet  fresh  earth,  common  salt  or  a  slice  of 
an  onion  may  also  be  employed.  Stimulants  may  be 
indicated  in  some  cases. 

Wounds  of  the  abdominal  walls  are  very  dangerous, 
particularly  so  if  the  injury  extends  to  the  abdominal 
cavity,  which  is  frequently  the  case.  The  external 
opening  is  often  sufficiently  large  to  allow  the  escape 
of  the  bowels  or  intestines.  If  this  occurs,  the  mass 
should  be  covered  with  clean  cloths  wrung  out  in  hot 
water  for  protection  until  the  physician  arrives.  Over 
this  application  should  be  placed  other  material,  which 
tends  to  retain  the  warmth  and  offers  gentle  support. 
A  wound  of  the  abdominal  walls  which  does  not  enter 


282  GOOD  HEALTH 

the  cavity,  although  in  some  instances  dangerous, 
should  be  treated  as  an  ordinary  wound.  The  shock 
which  accompanies  abdominal  wounds  must  receive 
appropriate  treatment. 

Wounds  of  the  thorax  or  chest  are  often  associated 
with  injury  of  the  lung.  Should  this  complication  ex- 
ist, it  can  be  recognized  by  pain  and  irritation,  cough- 
ing, difficult  breathing,  hemoptysis,  or  spitting  of  blood, 
and  the  appearance  of  blood  and  mucus  in  the  expec- 
toration. Sometimes  air  enters  the  pleural  cavity, 
which  greatly  increases  the  size  of  the  chest  on  the 
affected  side. 

When  this  condition  is  present,  the  external  wound 
should  be  closed,  a  compress  and  bandage  firmly  ap- 
plied, and  the  patient  placed  in  a  recumbent  position. 
If  great  distress  follows,  the  dressing  must  be  re- 
moved and  the  patient  turned  on  the  side  where  the 
wound  is,  thus  favoring  the  escape  of  accumulated 
blood  in  the  chest. 

Rest  is  essential  in  the  proper  healing  of  wounds 
and  should  be  insisted  upon,  particularly  if  the  in- 
jury is  of  a  serious  nature.  The  limbs  may  be  kept 
quiet  by  the  use  of  splints  or  slings. 

FRACTURES 

A  fracture  is  a  breaking  or  solution  of  continuity 
in  a  bone.  While  there  is  an  extended  classification  of 
fractures,  it  will  be  sufficient  in  connection  with  prompt 
aid  work  if  two  kinds  are  borne  in  mind :  simple  and 
compound  fractures. 

A  simple  fracture  is  one  in  which  the  bone  is  broken 


PROMPT  AID  TO  THE  INJURED  283 

into  two  fragments,  the  ends  of  which  do  not  pro- 
trude through  a  puncture  of  the  skin  or  seriously  in- 
jure adjacent  structures. 

In  a  compound  fracture,  the  broken  bone  penetrates 
the  soft  tissue  and  communicates  with  the  air. 

A  fracture  is  either  complete  or  incomplete.  A 
complete  fracture  is  the  usual  variety,  and  involves 
the  entire  separation  or  loss  of  continuity  of  a  bone. 
An  incomplete  fracture  not  infrequently  occurs  in  chil- 
dren, owing  to  the  elasticity  of  bone  in  early  life,  and 
has  received  the  name  of  partial  or  "greenstick"  frac- 
ture. 

The  signs  and  symptoms  of  a  fracture  are  deformity, 
abnormal  mobility  at  the  point  of  fracture,  bony 
crepitus,  or  grating,  when  the  divided  parts  are  rubbed 
together,  pain,  loss  of  function  and  subsequent  swell- 
ing and  discoloration.  Surgeons  now  employ  the  x- 
ray  as  a  means  of  diagnosis  in  these  cases. 

The  repair,  union,  or  knitting  of  the  bone  is  begun 
by  nature  soon  after  the  fracture  and  is  accomplished 
by  a  substance  formed  at  the  seat  of  injury  known 
as  callus  or  cement,  which  is  thrown  around  and  be- 
tween the  ends  of  the  broken  bone.  Although  soft  at 
first,  this  material  gradually  hardens  and  firmly  unites 
the  bones. 

Treatment. — The  object  of  a  surgeon  in  treating  a 
fracture  is  to  assist  nature.  He  first  carefully  reduces 
the  fracture  or  sets  the  bone ;  that  is,  he  endeavors  to 
bring  the  broken  ends  in  apposition  or  directly  against 
each  other  in  proper  place,  and  to  retain  them  in  po- 
sition for  a  certain  length  of  time  by  splints  or  some 


284  GOOD  HEALTH 

other  form  of  support  until  the  callus  has  performed 
its  function. 

Although  it  is  best  that  a  fracture  should  be  re- 
duced and  the  proper  dressing  applied  as  quickly  as 
possible  after  the  accident,  it  should  be  remembered 
that  the  union  of  the  fragments  does  not  begin  at 
once,  and  that  a  fracture  inay  remain  some  days  before 
being  reduced  and  still  be  followed  by  excellent  re- 
sults. It  should  also  be  remembered  that  a  frequent 
cause  of  compound  fracture  is  unskillful  manipulation. 

When  a  person  not  a  doctor  of  medicine  is  called 
upon  to  give  prompt  aid  where  a  fracture  is  suspected, 
his  duty  consists  in  protecting  and  making  immovable 
the  injured  part,  and  carefully  conveying  the  patient 
to  the  hospital  or  some  place  where  he  can  receive  the 
attention  of  a  physician. 

An  injured  person  suspected  of  having  a  fracture 
should  not  be  moved  from  the  position  in  which  he  is 
found  until  an  examination  is  made  as  to  the  charac- 
ter of  the  injury.  A  violation  of  this  rule  is  often 
the  cause  of  compound  fractures. 

A  brief  account  of  the  manner  in  which  the  injury 
was  received  should  be  obtained  from  the  patient  or  a 
bystander.  An  examination  should  then  be  made.  If 
the  injury  is  about  the  ankle  or  wrist  it  can  be  easily 
exposed.  However,  if  closer  to  the  body,  the  cloth- 
ing should  be  cut  away  and  not  removed  in  the  ordi- 
nary manner  which  would  be  likely  to  disturb  the 
fragments  of  the  bone.  If  practicable  the  garments 
may  be  ripped  at  the  seams. 

After  the  seat  of  injury  has  been  examined  and  the 


PROMPT  AID  TO  THE  INJURED  285 

presence  of  the  fracture  suspected,  the  clothing  previ- 
ously turned  aside  can  now  be  replaced  and  wrapped 
around  the  part,  thus  affording  considerable  protection 
to  it.  The  splint  should  then  be  adjusted  and  the  pa- 
tient removed  to  a  place  where  he  can  have  the  proper 
medical  treatment. 

Splints  can  be  made  of  any  material  which  is  capa- 
ble of  rendering  the  part  practically  immovable  with- 
out injuring  the  soft  structures  to  which  they  are  ap- 
plied. They  should  be  long  enough  to  extend  some 
distance  above  and  below  the  injury,  generally  includ- 
ing the  nearest  joint,  and  at  times,  two  or  three  joints, 
as  in  a  fracture  of  the  thigh.  Their  diameter  should 
exceed  that  of  the  limb  to  which  they  are  applied,  al- 
though this  is  not  altogether  necessary,  as  a  cane,  um- 
brella or  sword  makes  a  fair  support.  Two  splints 
are  generally  used,  one  for  the  inner  and  the  other 
for  the  outer  side  of  the  limb.  Splints  should  also 
be  padded  on  the  side  next  to  the  skin  with  some  soft 
material  so  as  to  prevent  undue  pressure  and  injury. 
After  a  splint  has  been  fitted  to  the  limb  it  should  be 
retained  by  bandages  of  some  kind.  The  latter,  how- 
ever, should  not  be  placed  next  to  the  skin  at  the 
point  of  fracture,  nor  should  they  be  drawn  so  tight 
around  the  splints  as  to  increase  the  suffering  of  the 
patient. 

Although  thin  wooden  boards  make  very  valuable 
splints  in  emergency,  for  they  are  light  and  easily 
formed  to  suit  special  cases,  other  material  may  be  em- 
ployed with  good  results.  Among  those  which  can  be 
used  in  emergencies  are  shingles,  lathes,  fence-boards. 


286  GOOD  HEALTH 

portions  of  cigar  boxes,  barrel  staves,  bark  of  trees 
or  even  branches  of  trees,  binders'  board,  book  covers, 
leather  and  innumerable  other  articles.  More  re- 
cently, heavy  wire  netting  is  supplied  for  this  purpose ; 
even  a  number  of  newspapers  tightly  folded  together 
may  be  used  as  a  splint.  A  pillow  or  an  article  of 
clothing  properly  folded  may  be  used  as  a  splint  and 
pad  combined. 

For  padding,  cotton  or  any  soft  substance  may  be 
used,  such  as  articles  of  clothing,  furniture,  stuf- 
fing, straw,  hay,  etc.  Bandages  for  retaining  the  splint 
may  be  purchased  in  any  drugstore.  Handkerchiefs, 
neckties,  suspenders,  strips  of  clothing  and  straps  may 
also  be  used. 

The  danger  which  follows  a  want  of  knowledge  on 
this  point  relates  chiefly  to  the  fact  that  a  fracture  may 
be  transformed  from  a  simple  to  a  compound  one  by 
forcing  the  ends  of  the  bone  through  the  skin  or  by 
injuring  blood-vessels,  nerves  and  other  tissues. 

The  danger  of  a  compound  fracture  is  very  great, 
for  it  not  only  diminishes  the  chance  of  securing  a 
good  bone  union,  but  it  is  apt  to  cause  blood  poison- 
ing and  sloughing  of  tissue,  not  infrequently  with 
fatal  results. 

With  this  point  well  in  mind,  the  need  of  fixation 
at  the  point  of  fracture  and  the  importance  of  con- 
fining nearby  joints,  in  order  that  they  may  not  disturb 
the  ends  of  the  bone,  is  apparent.  If  these  principles 
are  firmly  adhered  to,  those  who  are  called  upon  to 
render  prompt  aid  will  be  able  to  perform  valuable 
service  in  this  emergency. 


PROMPT  AID  TO  THE  INJURED  287 

DISLOCATIONS 

A  dislocation  or  luxation  is  a  forcible  displacement 
of  one .  articular  surface  of  a  bone  from  another,  and 
may  be  the  result  of  direct  violence  or  muscular  con- 
traction. More  or  less  rupture  of  the  ligaments  about 
the  joints  always  takes  place.  The  chief  signs  of  a 
dislocation  are  deformity  and  loss  of  function  of  the 
joint.  The  mobility  of  the  part  is  greatly  diminished, 
while  in  fractures  a  false  point  of  motion  occurs  as 
the  shaft  of  the  bone  is  usually  injured. 

The  reduction  of  a  dislocation  requires  considerable 
technical  skill,  and  should  be  performed  only  by  a 
physician.  For  this  reason  it  is  necessary  to  remove 
the  patient  as  promptly  as  possible  to  a  place  where 
proper  treatment  can  be  obtained. 

SPRAINS 

A  sprain  is  a  wrenching  or  twisting  of  a  joint,  as- 
sociated with  considerable  stretching  or  tearing  of  the 
tendons  and  ligaments  in  the  vicinity.  Sprains  occur 
most  frequently  at  the  ankle  or  wrist.  Pronounced 
swelling  and  pain  rapidly  ensue.  Fractures  at  or  near 
the  joints  are  very  frequently  mistaken  for  sprains. 
In  some  cases,  it  is  difficult  or  impossible  to  decide 
between  them ;  therefore,  the  value  of  an  x-ray  exami- 
nation is  apparent. 

Many  so-called  sprains  are  really  fractures  and  are 
improperly  treated,  with  resulting  deformities  of  the 
part.  Therefore,  one  who  is  not  a  physician  should  be 
exceedingly  careful   in   giving   an   opinion   regarding 


288  GOOD  HEALTH 

an  injury  of  this  kind  and  should  not  suggest  treat- 
ment. It  is  very  much  safer  to  refer  the  person  in- 
jured to  someone  who  is  properly  qualified  to  treat  the 
condition. 


INDEX 


Abdominal  wounds,  281,  282 
Acid    fruit    juices,    value   of, 

113,    114 

Acid  solutions  for  alkaline 
burns,  272 

Acids,   burns   from,  271,  272 

"Adam's  apple,"  32 

Aerial  infection,  201 

Air,    composition    of,    62 
for  heat  stroke,  263 
for  suffocation,  265,  266 
importance     of     fresh,     ^, 

133,  134 
impurity  of,  64,  135 
pressure   of,  68 
purification  of,    136 
Air   cells,   33,   35 
Air   supply,   amount   of,    134, 
138,    139 
during  sleep,  164,  165 
Alcohol,       for       hemorrhage 

from  the  mouth,  247 
Alcoholic    drinks,     120,     148, 

149 
Alimentary   tract,    length    of. 

Alkalies,  burns  from,  caus- 
tic, 272 

Alkaline  powders  for  acid 
burns,  271,  272 


Alum,  for  hemorrhage,  247 
Animal  bites,   treatment   for^ 

280,  281 
Animal  matter  in  bone,  2 
Anopheles  mosquito,  205,  209,. 

210 
Antibodies,  195,  196 
Antiseptics,   235,   237 
Antitoxin,   195-198 
Anus,  44 
Aorta,   23,  24 
Aponeurosis,  17 
Apoplexy,  25,   57,    150 

treatment  for,  258-260 
Appendicitis,  44 
Appendix,  44 
Apples,    113 
Arm,  bones  of,  9,  10 
Arterial  blood,  21 
Arterial    hemorrhage,    treat- 
ment for,  243-245 
Arterial    walls,    strength    of, 

24 
Arteries,  elasticity  of,  24,  25 

function  of,  23 

pulsation  of,  24 

structure  of,  24 
Artesian  wells,  78 
Articulations,  movements  of, 
13 


289 


290 


INDEX 


-Artificial  respiration,  252-256, 

265,  269 
Asphyxiation,   treatment   for, 

265,  266 

Astringents   for  hemorrhage, 

247,  248 

Atlantic  coast  mosquito,  211, 

212 
-Atmosphere,  weight  of,  68 
Atrophy   of    muscles,    18 
-Auricles,  28,   29 

Bacilli,  193 
Backbone,  6 

-bacteria,  body  resistance  to, 
198 
classification  of,   193 
destruction  of,  in  blood,  20, 

21,   195 
discovery  of,  192,  193 
examination  of,  194 
harmless,  198,  199 
in   milk,    loi 
in  water  supply,  jy,  81,  84, 

123,   126,   127 
multiplication  of,  194 
toxins  of,   195,    196 
See  also  Infection 
Bacteriology,   193 
Ball  and  socket  joint,  move- 
ments of,  13 
^Banana,   1 13 
'Baseball  players,  exercise  of, 

15s 
^ath  tubs,   157 
3aths,  effect  of,  on  digestion, 

159,  160 


Baths,  frequency  of,  157 

temperature  of,  158 
Beans,  112 
Beds,  165 
Beef,  108 
Beriberi,   112 
Bicarbonate     of     soda     for 

burns,  270,  271 
Bile,   secretion  of,  45,  46 
Bladder,  48 

Blisters  from  burns,  270,  271 
Blood,   circulation   of,  23,  2^ 

coagulation  of,  21 

color   of,   21 

composition  of,   19,  20 

functions  of,   19 

specific  gravity  of,  21 
Blood   pressure,    in   arteries, 
24 

in  veins,  26 
Blood'  supply  for  muscles,  17 
Blood-vessels  in  skin,  49 
Blue  vitriol,  238 
Boiled   milk,    102,    103 
Boiled  water,  83,  179 

as    disinfectant,    232,    235, 

Bone,  composition  of,  2,  3 

nutrition  of,  4 
Bones,    arrangement    of,    in 
skeleton,  5 

fractures  of,  282-286 

number  of,   5 

shape  of,  4,  5 
Boric  acid  for  burns,  270 
Bottled  water,  81 
Brain,  position  of,  6,  53 


INDEX 


291 


Brain,  structure  of,  53,  55 

weight  of,  57 
Brain  workers,  exercise  for, 

154,  155 
Bread,   11 1 
Breakfast,    116,    117 
Breast  bone,  8 
Broken  arch,  12 
Bromin,  as  deodorant,  22^^ 
Bronchi,    2}Z 
Bubonic  plague,  202 
Bunions,    162 
Burns,    treatment    for,    269- 

272 
Butter,  100,  no 

Callus,  formation  of,  283,  284 
Calories,  93 
Canals,  in  bones,  3,  4 
Cancellated    tissue    of    bone, 

2,    3 
Candle  lighting,  144 
Capillaries,    function    of,    25, 

26,  27 
Capillary     hemorrhage,     243, 

244,  246 
Carbohydrates,  88 
Carbolic  acid,  235 
Carbon  dioxid,  in  air,  62,  63 
Carbonic    acid    gas    in    wells, 

266 
Carburetted  hydrogen,  65 
Carpets,    176,    177 
Carpus,    10 

See  also  Wrist 
Carron  oil  for  burns,  270 
Cartilage,    13,    14 


Castor  oil,   173 

Cathartics,    173 

Cauterization  of  animal  bites^ 
280,   281 

Cellar,  care  of,  179 

Central  nervous  system,  func- 
tion of,  52,  59 

Cereals,    91,    no 

Cerebellum,    55,    56 

Cerebrospinal  nervous  sys- 
tem,   52,    53 

Cerebrum,     convolutions     of^ 

53,  55 
function  of,  55 
structure  of,  53 
Certified   milk,    102 
Cesspools,    128,    129,    180 
Chalk   for   burns,   270,   271 
Charcoal  for  burns,  270 
Cheese,  100,  loi,  no 
Chemical  burns,  271,  272 
Chest,   5 

wounds    in,    282 
Children,  as  fly  catchers,  223^ 
224 
effect  of  tea  and  coffee  on, 

149 
hygiene  instruction  to,  185, 

186 
medical  inspection  of,   181, 
182 
Cholera,  bacteria  of,  194 
Chyle,  formation  of,  47 
Circulation   of    blood,  23,  2^ 
effect  of   exercise  on,   150, 

151 
Clavicle,  8,  9 


292 


INDEX 


Cleanliness  in  household,  176 
in   schools,    185,    186 
in   work   shops,    187 

Clothing,  materials  of,  166 

Coagulation  of  blood,  21 

Coal  gas,  142 

Coal  stoves,  141,  142 

Cocci,    193 

Coccyx,    1 1 

Coffee  drinking,   149 

Cold    applications,    for    apo- 
plexy, 259 
for  heat-stroke,  263,  264 
for   hemorrhage,   246,   247, 
248,  259 

Cold  baths,  158 

Cold    weather,    clothing    In, 
168-170 

Colds,    136,    137,    158,    170 

Colic,   44 

Collar  bones,  8 

Colon,  44 

Compact  tissue  of  bone,  2, 3 

Complemental    air    in    lungs, 
36 

Compound  fractures,  284,  2S6 

Condensed  foods,   99,   100 

Congestion,  relief  of,  150,  151 

Constipation,  causes   of,   171, 
172 
treatment  for,   172,   173 

Consumption  cures,  231 
See  also  Tuberculosis 

Convalescence,    .diet    during, 
90 

Convulsions.    See  Apoplexy; 
Epilepsy 


Cooking,     methods     of,     115, 

116 
Copper,  sulphate  of,  237,  238 
Copper  lime  solution,  238,  239 
Corns,  162 

Corpuscles,  in  blood,  19,  20 
Corrosive  sublimate,  235 
Cotton,   166,   168 
Cows,  modern  care  of,  227 
Crabs,  109 
Cramps,   159,   160 
Cranium,  5 
Cream,   100 
Culex  pipiens  mosquito,  209 

Death,  from  burns,  270 
from   drowning,   267 
from  freezing,  273 
from  heat-stroke,  263 
from    snake-bite,   276 
from  suffocation,  265 

Dental  clinics,  report  of,  160 

Deodorants,  180,  235,  237-239 

Derma,  49 

Diaphragm,  9 
movements  of,  35 

Diet,   90 

for  constipation,  172 
for  convalescence,  90 
for  hard  labor,  94 
for  sedentary  life,  94 
for  weight  reduction,   119- 

121 
idiosyncrasy  in,  98 
reformation  of,   148,   149 
standardizing  of,  93 

Diet  tables,  95-97 


INDEX 


293 


Diffusion  of  gases,  64,  134 
Digestion,  89 

in  small  intestine,  42,  43,  46, 

47 
in  stomach,  41,  42 

Digestive   disturbance  during 
bathing,  159,  160 

Digestive  fluids,  secretion  of, 
39,  42,  45,  46,  47 

Diphtheria,  antitoxin  for,  196 
transmission    of,    loi,    183, 
185,  203 

Dipped  milk,  103 

Disease     carriers,     127,     153, 
177,    181,  201,   202,  204 
transmission  of.      See    In- 
fection 

Disinfectants,  235,  22,6 

Dislocations,    treatment    for, 
287 

Drafts,  136,  137,  165 

Drainage  of  mosquito  breed- 
ing places,  218-220 

Drainage  system,  construction 
of,  123-125 

Drains,   125,   180 

Dressing    for  fractures,  283- 
286 
for  wounds,  278,  279 

Drinking   cups,   infection  by, 
188 

Drow^ning,      treatment      for, 
267-269 

Duodenum,  43 

Earth  closets,  128 
Earthy  matter  in  bone,  2 


Eggs,  food  value  of,  109,  no 
Elasticity   of   arteries,   24,  25 
Electric  fans,  67,  191 
Electric  heating,    143 
Electric  lighting,  146 
Electric  shock,  treatment  for, 

252-256 
Emulsification  of   fat,  46,  47 
Enamel  of  teeth,  39 
Endocardium,  31 
Epidermis,  49 
Epiglottis,  32 
Epilepsy,  treatment  for,  260, 

261 
Epistaxis,  248 
Esophagus,  postion  of,  32,  40 

structure  of,  40 
Excretion,  22 

nerve  control  of,  59 
Exercise,    function    of,    150, 

151 
Eyes,   examination   of,    162 

Fainting,  treatment  for,  256- 

258 
Fascia,  16 
Fat,  88,  90 

Fat  people,  treatment  for,  119 
Feet,  care  of,  162,  163,  170 
Femur,    11 

Fermented  milk,  104,  105 
Fibula,  II 
Filtration  of  water  supply,  y6, 

77 
Fire,  burns   from,  2^2 
Fire-damp,  65 
Fish,  food  value  of,  108,  109 


294 


INDEX 


Fits.      See    Epilepsy;    Apo- 
plexy- 
Flat  bones,  5 
Flat  foot,  12 
Fleas,  infection  by,  202 
Flies,  breeding  places  of,  130, 
132,   178,  221,  222 
extermination   of,   223,  224 
hibernation  of,  220 
infection  by,   127,  202,  222 
propagation   of,   220,  221 
varieties   of,  222 
Floating  ribs,  8 
Fluid  drainage  by  lymphatics, 

60,   61 
Fontanelles,  6 

Food,  at  social  functions,  148, 
149 
classification   of,   87 
contamination   of,   223 
cooking  of,   115,   116 
digestion  of,  89 
Food  extracts,  99,  100 
Food  supply  for  various  tis- 
sues, 86,  87 
Foot,  bones  of,   12 
Footwear,  163,   170 
Foramen  magnum,  8 
Foreign   bodies,   removal   of, 

from  wounds,  278 
Fractures,     classification     of, 
282,  283 
treatment  of,  283-286 
Friction  for  frost-bite,  274 
Frost-bite,  treatment  for,  273, 

274 
Fruit,  113 


Fruit,  contamination  of,  114, 

Fuel  value  of   food,   91,  92, 

93 
Fur,  166,  167 
Furnace  heat,   143 
Furniture,    177 

Gall-bladder,  46 

Game,  108 

Ganglionic   system,    59 

Garbage,  reduction  of,   131 

disposal  of,  in  country,  132 
methods  of,  131,  132 
Gas   lighting,   145 
Gases, proportion  of,  in  air,  62 
Gastric  juice,  secretion  of,  42 
Germs,    body    resistance    to, 
198 

classification  of,  193 

destruction  of,  in  blood,  20, 
21,   195 

discovery  of    192,  193 

examination   of,    194 

harmless,  198,  199 

in  milk   loi 

ir  water  supply,  yy,  81,  84, 
123,  126,  127 

multiplication  of,  194 

toxins  of,  195,  196 

See  also  Infection 
Gland,  21 
Golf,   152 

Granulation  of  wounds,  277 
Grate  fires,  138,  141 
Gravel,  passage  of,  from  kid- 
neys, 48 


INDEX 


295. 


Greenstick    fracture,    283 
Gristle,  13 
Gullet,  32,  40 
Gunshot  wounds,  275 
Gymnasium,  152 

Hair  follicles,  51 
Hand,  bones  of,  10 

care   of,   163 
Hard  water,  ^2 
Hardened  arteries,  25 
Haunch  bones,  10,  11 
Heart,   blood    circulation    in, 

27 
chambers  of,  28 
mechanical  energy  of,  30 
muscle  tissue  of,  18 
pulsation   of,  29,  30 
size  and  position  of,  28 
Heat  as   disinfectant,  235 
Heat  conduction  of  clothing, 

166,   167,   168 
Heat-stroke,  261 

treatment  for,  2,6z,  264 
Heating,   methods   of,   artifi- 
cial, 141 
Hellebore,    131 

Hemorrhage,  24,   25,  2.6,   150 
from     wounds,     2'J2,     273, 

279 
treatment  for  243-249 
Hinge   joint,   movements   of, 

13 

Horse,    production    of    anti- 
toxin from,  196 
Horseback  riding,   151 
Hot-air  heating,  143 


Hot  applications,  for  hemor- 
rhage, 246,  247 
for  shock,  250,  251 

Hot  springs,  71,  72 

Hot-water  heating,  143 

House  cleaning,  methods  of,. 
177,   178 

House  drains,  125,  180 

House  fly.    See  Flies 

Housemaid's  knee,   12 

Humerus,   9 

Humidity,  in  air,  67 

Hygiene  instruction  in  school,. 
185,  186 

Hyoid  bone,  8 

Hypertrophy    of   muscles,    18: 

Hysteria,  treatment  for,  261,. 
262 

Ice,  for  heat-stroke,  264 
for   hemorrhage,   246,   248,. 

259 
Icebox,  care  of  178,  179 
Ice   supply,   84 
Ileum,  43 
Imbibition,    14,   21 
Impure  air,  causes  of,  64 
danger  of,  65,  135 
effects  of,   139,   140 
Incineration  of  garbage,  131, 

132 
Incised  wounds,  274 
Infection,  antitoxin  treatment 
for,   195,   196,   197 
body  resistance  to,  198, 230 
by    insects,    127,    153,    178, 
181,   202,  204,  206,  223 


296 


INDEX 


Infection,  carriers  of,  201,  202 
fomites  theory  of,  199,  200 
in  school,  183,  185 
in  workshops,   187,  188 
of  milk,  loi,  223,  226 
of  water  supply,  yj,  81,  84, 

123,    126,    127 
of  wounds,  275 
protection   against,   83,   84, 
.  102,    179-183,    185,    187, 
188,  190,   198,  203,  217, 
220,  223 
sources  of,  201,  223 
transmission  of,   193 
Ingrowing  nails,  162 
Inorganic  foods,  89 
Insects,    as    disease    carriers, 
127,   153,   177,   181,  202, 
205,  206 
destruction    of,    in    apart- 
ments, 239-241 
Insect   stings,   treatment   for, 

281 
Insolation,  262 
Insomnia,  164 
Inspected   milk,    102 
Instep,  bones  of,  12 

movement  of,  13 
Intemperance  in  diet,  147-149 
Intestines,    small    and    large, 

42-44 
Intoxication,  259,  260 
Involuntary  muscles,  15 
movement  of,   18 
nerve  control  of,  59 
lodin,       tincture       of,       for 
wounds,  278 


Iron,  for  hemorrhage,  247 
Irregular  bones,  5 

Jejunum,    43 
Joint  oil,  15 

Joints,   formation  of,   13 
movements  of,  13 

Kidneys,    function   of,   47 
size  and  position  of,  47 
Kitchen,  care  of,  178,  179 
Knee-cap,    12 
Koch,  193,  226 
Kumyss,   104,    105,    106 

Lacerated  wounds,  275 
Lacteals,   47 
Lake  water,   "jd 
Lamb,   108 
Large  intestine,  44 
Larynx,  position  of,  32 
Laveran,   Dr.,   204 
Leather  clothing,  167 
Leg,  bones  of,  10-12 
Lemon  juice,  114 

for  chemical  burns,  272 
Leukocytes,  20,   195 
Lice,  202 
Licorice,  173 
Ligaments,   14 
Lighting,  methods  of,  144 
Lime,  chlorid  of,  2.2,7 

in  food,  89 

unslaked,  238 
Lime  water  for  burns,  270 
Linen,    166 
Liver,  functions  of,  45 


INDEX 


297 


Liver,  size  and  position  of,  44, 

45 
Lobsters,    109 
Lockjaw,   17 

antitoxin  for,  196 

from  wounds,  289 
Long  bones,  construction  of, 

3,  4,  5 
Luncheon,   117,   118 
Lunchrooms     in     workshops, 

189 
Lungs,   blood   circulation   in, 
27 
capacity  of,  36 
size  and  position  of,  34 
wounds   in,   282 
Lymphatic    glands,     function 

of,  61 
Lymphatic  system,   60 
Lymphatics,  of  bone,  4 
of  intestines,  47 
of  muscle,  17 
of  skin,  49 

Mackintoshes,    167 
Magnesia,   for  burns,  270 

in  food,  89 
Malaria,  bacteria  of,  204,  205 

spleen  in,  52 

transmission  of,  153 
Manure,  disposal  of,  130, 221 
Marrow,  composition  of,  3 
Mastication,  37,  39 
Meals,  116-118 
Measles,  183/  185,  203 
Meat,  91 

contamination  of,    107,   108 


Meat,  food  value  of,  107 
Medical        examination       of 
school     children,     182, 

183 
Medulla  oblongata,  57 
Meningitis,  bacteria  of,  194 
Metabolism,  90 
Metacarpus,    10 
Metatarsal  bones,  12 
Microbe.         See       Bacteria ; 

Germs 
Microscopic  study  of  germs, 

194 
Milk,  composition  of,  100 
contamination  of,  loi,   103, 

223,  226 
fermentation  of,  104 
preservatives  of,  103 
supply  of,  sources  of,  loi, 
102 
Mineral  waters,  72 
Mines,  gases  in,  64,  65 
Mixed    diet,   90,    112,    147 
Moisture  in  air,  62,  63,  70 
Money,  infection  by  old,  200 
Mosquitoes,    breeding    places 
of,  212-214 
extermination  of,  181,  204, 

217-220 
habits  of,  214-217 
hibernation  of,  217 
in  storage  tanks,  75 
malarial,  153,  202,  205,  209, 

210 
migration  of,  215,  216 
propagation    of,    207,    208, 
216,  217 


298 


INDEX 


Mosquitoes,  varieties  of,  209- 
212 
yellow-fever,  206,  211 
Motor  nerves,  57,   58 
Mouth,     hemorrhage     from, 

247,   248 
Movements,   of  joints,   13 

of  spine,  6 
Mucous  coat  of  stomach,  41, 

42 
Mucous  membrane,  definition 
of,  2.2. 
of  respiratory  tract,  34 
Municipal    disposal    of    gar- 
bage, 131 
Municipal  inspection  of  sew- 
er system,  125 
Municipal  regulation,  of  milk 
supply,  102,  106 
of  ventilation,  139 
of  water  supply,  82,  83 
Municipal  sanitary  construc- 
tion,  123 
Musca  domestica.     See  Plies 
Muscle   fiber,    kinds    of,    15, 

18 
Muscles,  arrangement  of,  15 
attachment  of,  to  bone,  17 
contraction  of,  17,  18 
function  of,   15 
importance   of   activity  to, 

18 
nourishment  of,  17 
number  of,  15 
Muscular    coat    of    stomach, 

41,  42 
Mutton,  108 


Nails,  care  of,  163 

Necrosis,  4 

Nerves,  classification  of,  57 

of  bone,  4 

of  muscle,  17 
Nervous  system,  function  of, 

52 
Night  air,  153 
Nitrogen,   in  air,  62,  ^2^ 

in  food,  87,  88 
Non-vascular  tissue,   13 
Nose    bleed,    treatment    for, 

248 
Nourishment,       transmission 

of,  23,  27 
Nutrient  arteries  in  bones,  4 
Nutrition,   by   imbibition,    14, 
21 

distribution  of,  19,  20 
nerve  control  of,  59 

of  bone,  4 

of  cartilage,  13,  14 

of   muscles,  17 

problem  of,  86 

See  also  Food;  Diet 

Oatmeal,  fuel  value  of,  iir, 

112 
Obesity,   treatment   for,   119- 

121 
Offensive     odors,     123,     126, 

140,  156,  157,  160,  171, 

186,  187 
destruction  of,  237 
Oil  lamps,  144,  145 
Olive  oil  for  burns,  270 
Open  air  bathing,  159,  160 


INDEX 


299 


Open    air    exercise,    IS3-I5S. 

189,  190 
Open  air  sleeping,  (£,  165 
Open  fireplaces,  141 
Oranges,  113,   114 
Organ,  21 
Organic   food,    87 
Overeating,  98,  99,  147,  149 
Oxygen,    distribution    of,    in 

circulation,  19,  20 
in  air,  62,  63 
Oxygenation  of  blood,  27,  63 
Oysters,   109 
Ozone,  (£,  67 

Pancreas,  46 

Pancreatic  juice,  secretion  of, 

46,  47 

Paper  towels,   188 

Parotid  gland,  39 

Pasteur,    193 

Pasteur   treatment    for    dog- 
bites,  281 

Pasteurization   of    milk,    102, 
103 

Patella,   12 

Peas,   112 

Pelvic  bones,  10,  11 

Pelvis,  s 
construction  of,  11 

Pericardium,  31 

Periosteum,  4 

Perspiration,  49,  50,  51,  92 

Petroleum     for     mosquitoes, 
218 

Phalanges,  of  foot,  12 
of  hand,   10 


Pharynx,  40 

Pillovirs,   165,   166 

Plasma,  19,  20 

Pleura,  34 

Pleurisy,   34 

Plumbing,  in  modern  houses, 

124,  125 
Pneumonia,   bacteria   of,   194 
Poisoned  wounds,  275,  276 
Poisonous  gases,  in  mines,  65, 
265 

in  wells,  266 
Pons  Varolii,  56 
Porosity  of  clothing,  167 
Potatoes,  112,  113 
Poultry,  108 
Priestley,  Joseph,  62 
Privy  vaults,  126,  128,  180 

proper  construction  of,  127 
Proteins,  87,  88,  90,  91 
Ptomain  poisoning,  107 
Pulsation  of  heart,  29,  30 
Punctured  wounds,  275 
Pylorus,  41 

Radius,  9,  10 
Rain  barrel,  75 
Rain  barrel  mosquito,  209 
Rain  water,  72,  y^ 
Rectum,  44 
Red  corpuscles,  20 
Red  marrow,  3,  4 
Reduction  of  weight,  118-121 
Reserve  air  in  lungs,  36 
Residual  air  in  lungs,  36 
Respiration,  31 
air  supply  for,  134 


300 


INDEX 


Respiration,  nerve  control  of, 

57 
movements  in,  8,  g,  35 
Respiratory  tract,  31,  32 

mucous  membrane  of,  34 
Rest    rooms    in    workshops, 

188,   189 
Rest   treatment   for   wounds, 

282 
Resuscitation,        instructions 

for,  253-256 
Rheumatism,    prevention    of, 

161 
Ribs,  arrangement  of,  8,  9 
Rice,   112 
Rickets,  2,  87 
Rigor  mortis,  17 
River  water,  y6,  77 
Rowing,  152 
Rubber  baths,  157 
Rubber  clothing,  167,  170 
Rugs,  177 
Russian  baths,  159 

Sacrum,  11 

Saliva,  secretion  of,  39 
Salt,  89 

Salt  marsh  mosquito,  212 
Salt  water  bathing,  159 
Sanitary  conditions  in  coun- 
try, 126-130,   132 
Sanitary       construction,       in 
cities,  123 
in     private     houses,      124, 

125 
in  school  buildings,  184 
in  workshops,  187-191 


Sanitary  precautions   for  tu- 
berculosis, 232,  22s 
Scalds,    treatment    for,    272, 

273 

Scalp,  hemorrhage  in  the,  247 

Scapula,  9 

Scarlet  fever,  183,  185,  203 

School    buildings,    sanitation 
in,  184 

School  children,  hygiene   in- 
struction to,  185,  186 
inspection  of,   181,   182 

School  corps,  183 

Schoolhouse,    ventilation    of, 
184 

Scurvy,   113 

Seaside  excursions,  174 

Sebaceous  glands,  51 

Secretion,  22 
nerve  control  of,  5$ 

Sensory  nerves,  58 

Septic  tanks,  129,  130 

Serous  membranes,  definition 
of,  22 

Serum  treatment,    197 

Sewage  disposal,  122,  123 

Sewer  gas,  protection  from, 
124,  125,  266 

Sewer  system,  123 

Shin  bone,   11 

Shock,  treatment  for,  249-251 

Shoes,  163,  170 

Short  bones,  5 

Shoulder  blade,  9 

Sight,  examination  of,   162 

Silk,  166,  168 

Silver,  for  hemorrhage,  247 


INDEX 


301 


Skeleton,  construction  of,   i, 

2,  5 
number  of  bones  in,  5 
Skin,  functions  of,  48,  49 
glands  in,  49 
structure  of,  49 
waste    removal    from,    156, 

157 
Skull,  3,  5,  6,  8 
Sleep,  amount  of,  163 

body  position   during,    165, 
166 

purpose  of,  163 

ventilation  during,  164,  165 
Sleep-producing  drugs,  164 
Sleeping  sickness,  222 
Small  intestine,  digestion  in, 

42,  43,  44,  46,  47 
Smallpox,  183 

vaccine  for,   197 
Snake-bite,  276 

treatment  for,  280 
Soap,   157,  177,  178 

as    disinfectant,    232,    235, 
236 
Soda,  for  burns,  270,  271 

in  food,  89 
Soft  water,  72 
Soil  pipes,  124,  125 
Solicitans  mosquito,  211,  212 
Special  diets,  90,  91,  119-121 
Special  sense,  nerves  of,  58 
Spinal  cord,  position  of,  6,  57 
Spine,  construction  of,  6 
Spirilla,  193 
Spleen,  52 
Splint  bone,  11 


Splints  for  fractures,  283, 
285,  286 

Sprains,  treatment  for,  287, 
288 

Spring  water,  75,  76 

Sputum,  destruction  of  tuber- 
culous, 232 

Standard  diet,  93,  94 

Starch  for  burns,  270 

Starches,  88,  no,  in 

Steam    as    disinfectant,    232, 

235 
Steam  heat,  143 
Stegomyia  mosquito,  206,  211 
Sternum,  8 

Stimulants,  use  of,  in  prompt 
aid  to  injured,  251,258, 
263-265,  268,  274,  280 
Stomach,  coats  of,  41,  42 
digestion  in,  41,  42 
muscular    contractions    of, 

41,  42 
position  of,  40 
size  of,  41 
Storage  of  water  supply,  73, 

74,  75 
Storage  tanks,  care  of,  74,  75 
construction  of,  73,  74,  75 
Stoves,  141,  142,  143 
Strata,     passage     of     water 

through,  70,  71 
Striped  muscles,  15 
Styptics,  for  hemorrhage,  247 
Sublingual  gland,  39 
Submaxillary  gland,  39 
Suffocation,     treatment     for, 

265,  266 


302 


INDEX 


Sugar,  food  value  of,  90 

production  of,  in  liver,  45 
Sulphur  burning  for  insects, 

239-241 
Sulphur  dioxid  gas,  239-241 
Summer  clothing,  170,  171 
Sun-stroke,  262 
Sweat  glands,  49,  50,  51 
Sweeping,  178 
Swimming,  159,  160 
Sympathetic  nervous  system, 

59 
Syncope,  256-258 
Synovia,  15 

Synovial  membranes,  14,  15 
Synovitis,   15 

Tampon  for  hemorrhage,  247, 

248 
Tannin,  for  hemorrhage,  247 
Tarsus,  12 
Tea  drinking,  149 
Teeth,  arrangement  of,  38 

care  of,  160,  161 

formation  of  human,  2)7,  38 
Temperature,  indoor,  143 

of  baths,   158,   159 

regulation  of  body,  91,  92, 

93 
by  perspiration,  49 
variations  in,  in  winter,  168, 
169 
Tendons,  17 
Tennis,   152 
Tetanus,  17 
antitoxin  for,   196 
from  wounds,  280 


Thoracic  duct,  60 
Thorax,  5 
Tibia,  11 

Tidal  air  in  lungs,  36 
Tobacco,  149 
Tooth  powder,   161 
Touch,  sense  of,  49 
Tourniquet,  for  hemorrhage, 

245 
Towels,     infection     by,     187, 

188 
Toxin,  195,  196 
Trachea,  structure  of,  Z'^-,  ZZ 
True  skin,  49 
Tsetse  fly,  222 
Tub  baths,  157 
Tuberculin  test,  227 
Tuberculosis,  bacteria  of,  194, 
226,  228 
body  resistance  to,  230 
bovine,  226,  227 
cures  for,  230,  231 
detection  of,  231,  233,  234 
prevalence  of,  229,  230 
transmission    of,   202,    203, 

225,  226,  227,  229 
treatment  for,  65,  165,  230, 
231,  232,  '22,Z 
Turkish  baths,  159 
Typhoid    fever,    bacteria    of, 
194 
transmission  of,  77,  84,  lOi, 

126,  127 
vaccination   for,    197 
Typhoid  fly,  222 
Typhus    fever,    transmission 
of,  202 


INDEX 


303 


Ulna,  9,  10 

Underground    storage    tanks, 

75 
Underground    water    system, 

70 
Underwear,  materials  of,  167, 

168 
Unstriped  muscles,  15,  18 
Urea,  47 
Ureters,  48 
Urine,  excretion  of,  47,  48 

Vacations,  173 
Vaccine,  treatment,  197 
Vacuum  cleaning  process,  177 
Valves,  of  heart,  28 

of  veins,  26 
Varicose  veins,  26 
Vaseline  for  burns,  270 
Vegetarian  diet,  91 
Veins,  structure  of,  26 

valves  of,  26 
Venous  blood,  21 
Venous     hemorrhage,    treat- 
ment for,  243,  246 
Ventilating  devices,  137,  138 
Ventilation,  during  sleep,  164, 

165 

effect  of  bad,  139,  140 

in  schools  and  workshops, 
134,   184 

municipal  regulation  of,  139 

of  house,  135,  136 

of  workshops,  191 
Ventricles,  28,  29 
Vertebrae,  6 
Vesicles,  33 


Vinegar  for  chemical  burns, 

272 
Vocal  cords,  32 
Voluntary  muscles,   15-18 
contraction  of,  17 

Walking,   151-155,   189,   190 

Warm  baths,  158 

Warm  weather,  baths  in,  157 

clothing  for,   170,   171 

exercise  in,  155 
Waste    disposal    in    country, 

123,  126-129,  177 
Waste    matter,    flies   in,    127, 

130,  132,  221,  222 
Waste  pipes,  124,  125 
Waste  removal,  in  capillaries, 
26 

in  circulation,  19,  20 

in  kidneys,  47,  48 

in  liver,  45 

in  respiration,  2.^,  6z 

in  skin,  49,  50,  51,  156 
Waste  removal  glands,  21 
Water,  as  food,  89 

composition  of,  69 

drinking,  80 

passage     underground     of, 
70,  71 

storage  of,  ']2>,  74,  7S 
Water  filters,  81,  82 
Water  supply,  care  of,  76,  77- 
79,  82,  83 

mosquitoes  in,  213,  214 

on  shipboard,  84 

pollution  of,  72,  7A,  7S,  77j 
79,  84,  123,  126 


304 


INDEX 


Water  supply,  public  protec- 
tion of,  82,  83 
sources  of,  70,  ^z,  75»  76, 

17 
Well  water,  "JT,  78,  79 
Wells,  construction  of,  78,  79 

poisonous  gases  in,  266 
Wet   weather,   protection   in, 

170 
Wheat,  III 

White  corpuscles,  20,  21,  195 
White  fibrous   tissue,  in  ar- 
terial walls,  24 

in  ligaments,  14 

in  tendons,  17 
Whitewash,  179 
Wind-pipe,  32 
Winter,  clothing  in,  168,  169 


Winter,    temperature    varia- 
tions in,  168,  169 
Wool,  166,  167,  168 
Workshops,  sanitation  in,  187- 

191 
Wounds,      classification      of, 
274-276 
healing  of,  276,  277 
treatment  of,  277-282 
Wrist,  10 
movement  of,  13 

Yellow      elastic     tissue,      in 
blood-vessels,  24,  26 
in  ligaments,  14 

Yellow     fever,    transmission 
of,  206 

Yellow  marrow,  3 


(I) 


n 


^x^ 


^.> 


V 


